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ZOONOMIA; 

OR  THE 


m mm* 


IN  THREE  PARTS. 

BY  ERASMUS  DARWIN,  M.D.  F.R.S. 

AUTHOR  OF  THE  BOTANIC  GARDEN,  &C. 


Principid  ccelum,  ac  terras,  camposque  liquentes, 
Lucentemque  globum  lunte,  tifaniaque  astra, 
Spiritus  intds  alit,  totamque  infusa  per  artus 
Mens  agitat  molem,  et  magno  se  corpore  misoet. 

Virg  JEn.  vi. 

Earth,  on  whose  lap  a thousand  nations  tread, 

And  Ocean,  brooding  his  prolific  bed, 

Night’s  changeful  orb.  blue  pole,  and  silvery  zones. 
Where  other  worlds  encircle  other  suns, 

One  M«nd  inhabits,  one  diffusive  Soul 

Wields  the  large  limbs,  and  mingles  with  the  whole. 


COMPLETE  IN  TWO  VOLUMES. 

VOL.  II. 


FOURTH  AMERICAN  EDITION. 


PHILADELPHIA: 

PUBLISHED  BY  EDWARD  EARLE. 

CORNER  OF  FOURTH  AND  LIBRARY  STREET 

* 

William  Brown,  Printer. 

1818. 


V'  ( A 


s . 


! 


- 

OR, 


THE  LAWS  OF  ORGANIC  LIFE 

PART  II. 

CONTAINING 

A CATALOGUE  OF  DISEASES, 

DISTRIBUTED  INTO 

NATURAL  CLASSES, 

according  to  their  proximate  causes, 

WITH  THEin  SUBSEQUENT 

ORDERS,  GENERA,  AND  SPECIES, 

AND  WITH 

THEIR  METHODS  OF  CURE. 


Hzec,  ut  potero.  explieabo ; nec  tamen,  quasi  Pythius  Apollo,  certa  ut  sint  et  fixa,  quse  dixero 
wd  ut  Homunculus  unus  e multis  probabiliora  conjecture  sequens.  Cic.  Tusc.  Disp.  1.  1.  9. 


PREFACE. 


ALL  diseases  originate  in  the  exuberance,  deficiency, 
or  retrograde  action,  of  the  faculties  of  the  sensorium, 
as  their  proximate  cause;  and  consist  in  the  disordered 
motions  of  the  fibres  of  the  body,  as  the  proximate  ef- 
fect of  the  exertions  of  those  disordered  faculties. 

The  sensorium  possesses  four  distinct  powers,  or  fa- 
culties, which  are  occasionally  exerted,  and  produce  all 
the  motions  of  the  fibrous  parts  of  the  body;  these  are 
the  faculties  of  producing  fibrous  motions  in  conse- 
quence of  irritation,  which  is  excited  by  external  bo- 
dies; in  consequence  of  sensation,  which  is  excited  by 
pleasure  or  pain;  in  consequence  of  volition,  which  is 
excited  by  desire  or  aversion;  and  in  consequence  of 
association,  which  is  excited  by  other  fibrous  motions. 
We  are  hence  supplied  with  four  natural  classes  of  dis- 
eases derived  from  their  proximate  causes;  which  we 
shall  term  those  of  irritation,  those  of  sensation,  those 
of  volition,  and  those  of  association. 

In  the  subsequent  classification  of  diseases  I have 
not  adhered  to  the  methods  of  any  of  those  who  have 
preceded  me;  the  principal  of  whom  are  the  great 
names  of  Sauvages  and  Cullen;  but  have  nevertheless 
availed  myself,  as  much  as  I could,  of  their  definitions 
and  distinctions. 

The  essential  characteristic  of  a disease  consists  in 
its  proximate  cause,  as  is  well  observed  by  Doctor 


sj  q n 

C -J 


VI 


PREFACE. 


Cullen,  in  his  NosologiaMethodica,  T.  ii.  Prolegom.  p. 
xxix.  Similitude  quidem  morborum  in  similitudine  cau- 
sae eorum  proximas,  qualiscunque  sit,  revera  consistit. 
I have  taken  the  proximate  cause  for  the  classic  cha- 
racter. The  characters  of  the  orders  are  taken  from 
the  excess,  or  deficiency,  or  retrograde  action,  or  other 
properties,  of  the  proximate  cause.  The  genus  is 
generally  derived  from  the  proximate  effect.  And  the 
species  generally  from  the  locality  of  the  disease  in  the 
system. 

Many  species  in  this  system  are  termed  genera  in  the 
systems  of  other  writers;  and  the  species  of  those  wri- 
ters, are,  in  consequence,  here  termed  varieties.  Thus, 
in  Dr.  Cullen’s  Nosologia,  the  variola  or  small-pox  is 
termed  a genus,  and  the  distinct  and  confluent  kinds  are 
termed  species.  But  as  the  infection  from  the  distinct 
kind  frequently  produces  the  confluent  kind,  and  that 
of  the  confluent  kind  frequently  produces  the  distinct; 
it  would  seem  more  analogous  to  botanical  arrange- 
ment, which  these  nosologists  profess  to  imitate,  to  call 
the  distinct  and  confluent  small-pox  varieties  than  spe- 
cies. Because  the  species  of  plants  in  botanical  sys- 
tems propagate  others  similar  to  themselves;  which 
does  not  uniformly  occur  in  such  vegetable  productions 
as  are  termed  varieties. 

In  some  other  genera  of  nosologists  the  species  have 
no  analogy  to  each  other,  either  in  respect  to  their 
proximate  cause,  or  to  their  proximate  effect,  though 
they  may  be  somewhat  similar  in  less  essential  proper- 
ties; thus  the  thin  and  saline  discharge  from  the  nos- 
trils on  going  into  the  cold  air  of  a frosty  morning, 
which  is  owing  to  the  deficient  action  of  the  absorbent 
vessels  of  the  nostrils, is  one  species;  and  the  viscid  mucus 
discharged  from  the  secerning  vessels  of  the  same  mem- 
brane, when  inflamed,  is  another  species  of  the  same 
genus,  Catarrhus.  Which  bear  no  analogy  either  in 


PREFACE. 


Vll 


respect  to  their  immediate  cause,  or  to  their  immediate 
effect. 

The  uses  of  the  method  here  offered  to  the  public, 
of  classing  diseases  according  to  their  proximate  causes 
are,  first,  more  distinctly  to  understand  their  nature  by 
comparing  their  essential  properties.  Secondly,  to  fa- 
cilitate the  knowledge  of  the  methods  of  cure;  since  in 
natural  classification  of  diseases  the  species  of  each 
genus,  and  indeed  the  genera  of  each  order,  a few 
perhaps  excepted,  require  the  same  general  medical 
treatment.  And  lastly,  to  discover  the  nature  and  the 
name  of  any  disease  previously  unknown  to  the  physi- 
cian; which  I am  persuaded  will  be  more  readily  and 
more  certainly  done  by  this  natural  system,  than  by  the 
artificial  classifications  already  published. 

The  common  names  of  diseases  are  not  well  adapt- 
ed to  any  kind  of  classification,  and  least  of  all  to  this, 
from  their  proximate  causes.  Some  of  their  names 
in  common  language  are  taken  from  the  remote  cause, 
as  worms,  stone  of  the  bladder;  others  from  the  remote 
effect,  as  diarrhoea,  salivation,  hydrocephalus;  others 
from  some  accidental  symptom  of  the  disease,  as  tooth- 
ach,  head-ach,  heart-burn ; in  which  the  pain  is  only  a 
concomitant  circumstance  of  the  excess  or  deficiency 
of  fibrous  actions,  and  not  the  cause  of  them.  Others 
again  are  taken  from  the  deformity  occasioned  in  con- 
sequence of  the  unnatural  fibrous  motions,  which  con- 
stitute diseases,  as  tumours,  eruptions,  extenuations;  all 
these  therefore  improperly  give  names  to  diseases;  and 
some  difficulty  is  thus  occasioned  to  the  reader  in  en- 
deavouring to  discover  to  what  class  such  disorders  be- 
long. 

Another  difficulty  attending  the  names  of  diseases  is, 
that  one  name  frequently  includes  more  than  one  dis- 
ease, either  existing  at  the  same  time  or  in  succession. 


Vlll 


PREFACE. 


Thus  the  pain  of  the  bowels  from  worms  is  caused  by 
the  increased  action  of  the  membrane  from  the  stimu- 
lus of  those  animals;  but  the  convulsions,  which  some- 
times succeed  these  pains  in  children,  are  caused  by 
the  consequent  volition,  and  belong  to  another  class. 

To  discover  under  what  class  any  disease  should  be 
arranged,  we  must  first  investigate  the  proximate  cause; 
thus  the  pain  of  the  tooth-ach  is  not  the  cause  of  any 
diseased  motions,  but  the  effect;  the  tooth-ach  there- 
fore does  not  belong  to  the  class  of  Sensation.  As  the 
pain  is  caused  by  increased  or  decreased  action  of  the 
membranes  of  the  tooth,  and  these  actions  are  owing 
to  the  increase  or  decrease  of  irritation,  the  disease  is  to 
be  placed  in  the  class  of  Irritation. 

To  discover  the  order  it  must  be  inquired,  whether 
the  pain  be  owing  to  increased  or  defective  motion  of 
the  pained  membrane;  which  is  known  by  the  concomi- 
tant heat  or  coldness  of  the  part.  In  tooth-ach  with- 
out inflammation  there  is  generally  a coldness  attends 
the  cheek  in  its  vicinity;  as  may  be  perceived  by  the 
hand  of  the  patient  himself  compared  with  the  opposite 
cheek.  Hence  odontalgia  is  found  to  belong  to  the  or- 
der of  decreased  irritation.  The  genus  and  species 
must  be  found  by  inspecting  the  synopsis  of  the  second 
order  of  the  class  of  irritation.  See  Class  I.  2.  4.  12. 

This  may  be  further  elucidated  by  considering  the 
natural  operation  of  parturition;  the  pain  is  occasioned 
by  the  increased  action  or  distension  of  the  vessels  of 
the  uterus,  in  consequence  of  the  stimulus  of  the  fetus; 
and  is  therefore  caused  by  increased  irritation;  but  the 
actions  of  the  abdominal  muscles  in  its  exclusion  are 
caused  by  the  pain,  and  belong  to  the  class  of  increas- 
ed sensation.  See  Class  II.  1.  1.  12.  Hence  the  dif- 
ficulty of  determining,  under  what  class  of  diseases 
parturition  should  be  arranged,  consists  in  there  being 


PREFACE. 


IX 


two  kinds  of  diseased  actions  comprehended  under  one 
word;  which  have  each  their  different  proximate 
cause. 

In  Sect.  XXXIX.  8.  4.  and  in  Class  II.  1.1.  1.  we 
have  endeavoured  to  give  names  to  four  links  of  ani- 
mal causation,  w'hich  conveniently  apply  to  the  classifi- 
cation of  diseases;  thus  in  common  nictitation,  or  wink- 
ing with  the  eyes  without  our  attention  to  it,  the  in- 
creased irritation  is  the  proximate  cause;  the  stimulus  of 
the  air  on  the  dry  cornea, is  the  remote  cause;  the  clos- 
ing of  the  eye-lid  is  the  proximate  effect;  and  the  dif- 
fusion of  tears  over  the  eye-ball  is  the  remote  effect. 
In  some  cases  two  more  links  of  causation  may  be  in- 
troduced; one  of  them  may  be  termed  the  pre-remote 
cause;  as  the  warmth  or  motion  of  the  atmosphere, 
which  causes  greater  exhalation  from  the  cornea.  And 
the  other  the  post-remote  effect;  as  the  renewed  pellu- 
cidityof  the  cornea;  and  thus  six  links  of  causation 
may  be  expressed  in  words. 

But  if  amid  these  remote  links  of  animal  causation 
any  of  the  four  powers  or  faculties  of  the  sensorium  be 
introduced,  the  reasoning  is  not  just  according  to  the 
method  here  proposed;  for  these  powers  of  the  senso- 
rium are  always  the  proximate  causes  of  the  contrac- 
tions of  animal  fibres;  and  therefore  in  true  language 
cannot  be  termed  their  remote  causes.  From  this  cri- 
terion it  may  always  be  determined,  whether  more  dis- 
eases than  one  are  comprehended  under  one  name;  a 
circumstance  which  has  much  impeded  the  investiga- 
tion of  the  causes,  and  cures  of  diseases. 

Thus  the  term  fever  is  generally  given  to  a collec- 
tion of  morbid  symptoms;  which  are  indeed  so  many 

VOL.  it.  b 


X 


PREFACE, 


distinct  diseases,  that  sometimes  appear  together,  and 
sometimes  separately;  hence  it  has  no  determinate 
meaning,  except  it  signifies  simply  a quick  pulse,  which 
continues  for  some  hours;  in  which  sense  it  is  here 
used. 

In  naming  diseases  I have  endeavoured  to  avoid  the 
affectation  of  making  new  compound  Greek  words, 
where  others  equally  expressive  could  be  procured:  as 
a short  periphrasis  is  easier  to  be  understood,  and  less 
burdensome  to  the  memory. 

In  the  Methodus  Medendi, which  is  marked  by  M.  M 
at  the  end  of  many  of  the  species  of  diseases,  the 
words  incitantia,  sorbentia,  torpentia,  &c.  refer  to  the 
articles  of  the  Materia  Medica,  explaining  the  opera- 
tions of  medicines. 

The  remote  causes  of  many  diseases,  their  periods, 
and  many  circumstances  concerning  them,  are  treated 
of  in  the  preceding  volume;  the  descriptions  of  many 
of  them,  which  I have  omitted  for  the  sake  of  brevity, 
maybe  seen  in  the  Nosologia  Methodica  of  Sauvages, 
and  in  the  Synopsis  Nosologim  of  Dr.  Cullen,  and  in 
the  authors  to  which  they  refer. 

In  this  arduous  undertaking  the  author  solicits  the 
candour  of  the  critical  reader;  as  he  cannot  but  fore- 
see, that  many  errors  will  be  discovered,  many  addi- 
tional species  will  require  to  be  inserted ; and  others  to 
be  transplanted  or  erased.  If  he  could  expend  ano- 
ther forty  years  in  the  practice  of  medicine,  he  makes 
no  doubt,  but  that  he  could  bring  this  work  nearer  per- 
fection, and  thence  render  it  more  worthy  the  atten- 
tion of  philosophers, As  it  is,  he  is  induced  to  hope 

that  some  advantages  will  be  derived  from  it  to  the 


PREFACE. 


XI 


science  of  medicine,  and  consequently  utility  to  the 
public,  and  leaves  the  completion  of  his  plan  to  the  in- 
dustry of  future  generations. 

Derby,  Jan.  1,  1796. 


ZOONOMIA 


PART  II. 


CLASSES  OF  DISEASES. 

I.  DISEASES  OF  IRRITATION. 

II.  DISEASES  OF  SENSATION. 

III.  DISEASES  OF  VOLITION. 

IV.  DISEASES  OF  ASSOCIATION. 


The  Orders  and  Genera  of  the  First  Class  of  Diseases- 
CLASS  I. 

DISEASES  OF  IRRITATION. 

ORDO  I. 

Increased  Irritation. 

GENERA. 

1.  With  increased  actions  of  the  sanguiferous  system. 

2.  With  increased  actions  of  the  secerning  system. 

3.  With  increased  actions  of  the  absorbent  system. 

4.  With  increased  actions  of  other  cavities  and  membranes, 

5.  With  increased  actions  of  the  organs  of  sense. 

ORDO  II. 

Decreased  Irritation. 

GENERA. 

1.  With  decreased  actions  of  the  sanguiferous  system. 

2.  With  decreased  actions  of  the  secerning  system. 

3.  With  decreased  actions  of  the  absorbent  system 

VOL.  it,  B 


2 


DISEASES 


Class  1. 1.  2. 


4.  With  decreased  actions  of  other  cavities  and  membranes 

5.  With  decreased  actions  of  the  organs  of  sense. 

ORDO  III. 

Retrograde  Irritative  Motions. 

GENERA. 

1.  Of  the  alimentary  canal. 

2.  Of  the  absorbent  system. 

3.  Of  the  sanguiferous  system. 


The  Orders,  Genera,  and  Species,  of  the  First  Class  of 
Diseases. 

CLASS  I. 

DISEASES  OF  IRRITATION. 

ORDO  I. 

Increased  Irritation. 


GENUS  I. 


With  Increased  Actions  of  the  Sanguiferous  System 


SPECIES. 


1 . Febris  irritativa 

2.  Ebrietas 

3.  Hcemorrhagia  arteriosa 

4.  Hcemoptoe  arteriosa 

5.  Hcemorrhagia  nariurn 


Irritative  fever 
Drunkenness 
Arterial  Haemorrhage 
Spitting  of  arterial  blood 
Bleeding  from  the  nose 


GENUS  II. 


With  increased  Actions  of  the  Secerning  System. 

SPECIES. 


1 . Color  febrilis 

2.  Rubor  febrilis 

3.  Sudor  Calidus 

febrilis 

a labore 

ab  igne 

a medicamenlis 

4.  Urina  uberior  colorata 


Febrile  heat 
Febrile  redness 
Warm  sweat 
Sweat  in  fevers 

from  exercise 

from  fire 

from  medicines 

Copious  coloured  urine 


Class  I.  1.  3. 


OP  IRRITATION. 


3 


5.  Diarrhoea  calida. 

febrilis 

crapulosa 

infantum 

6.  Salivatio  calida 

7.  Catarrhus  calidus 

8.  Expectoratio  calida 

9.  Exsudatio pone  aures 

10.  Gonorrhoea  calida 

1 1 . Fluor  albus  calidus 

12.  Hcemorrhois  alba 

13.  Scrum  e visicatorio 

14.  Perspiratio fcetida 

15.  Crinesnovi 


Warm  diarrhoea 
Diarrhoea  from  fever 

from  indigestion 

of  infants 

Warm  salivation 

catarrh 

expectoration 

Discharge  behind  the  ears 
Warm  gonorrhoea 

fluor  albus 

White  piles 

Discharge  from  a blister 
Fetid  perspiration 
New  hairs 


GENUS  III. 

With  increased  Actions  of  the  Absorbent  System. 

SPECIES. 


1.  Lingua  arida 

2.  Fauces  arida 

3.  Mares  aridi 

4.  Expectoratio  solida 

5.  Constipatio  alvi 

6.  Cutis  arida 

7.  Urina  parcior  colorata 

8.  Calculus  felleus  et  icterus 

9.  renis 

10.  — vesica 

11.  arthriticus 

12.  Rheumatismus  chronicus 

13.  Cicatrix  vulnerum 

14.  Cornea  obfuscatio 


Dry  tongue 
Dry  throat 
Dry  nostrils 
Solid  expectoration 
Costiveness 
Dry  skin 

Diminished  coloured  urine 
Gall-stone  and  jaundice 
Stone  of  the  kidney 
Stone  of  the  bladder 
Gout-stone 
Chronic  rheumatism 
Healing  of  ulcers 
Scar  on  the  cornea 


GENUS  IV. 

With  increased  Actions  of  other  Cavities  and  Membranes 

SPECIES. 


1 . Nictitatio  irritativa 

2.  Deglutitio  irritativa 

3.  Respiratio  et  tussis 

4.  Exclusio  bilis 

5.  Dentitio 

6.  Priapismus 

7.  Distensio  mamniulamm 


Irritative  nictitation 
Irritative  deglutition 
Respiration  and  cough 
Exclusion  of  the  bile 
Toothing 
Priapism 

Distention  of  the  nipples 


4 


DISEASES 


Glass  I.  1. 


8.  Descensus  uteri 

9.  Prolapsus  ani 

10.  Lumbricus 

11.  Tania 

12.  Ascarides 

13.  Dracunculus 

14.  Morpiones 

15.  Pediculi 


Descent  of  the  uterus 

Descent  of  the  rectum 

Round  worm 

Tape-worm 

Thread-worms 

Guinea-worm 

Crab-lice 

Lice 


GENUS  V. 

With  increased  Actions  of  the  Organs  of  Sense. 
SPECIES. 


1. 

Viscus  acrior 

Acuter  sight 

2. 

Auditus  acrior 

hearing 

3. 

Olfactus  acrior 

smell 

4. 

Gustus  acrior 

taste 

5. 

Taclus  acrior 

touch 

6. 

Sensus  caloris  acrior 

sense  of  heat 

7. 

■ extensionis  acrior  sense  of  extension 

8. 

Titillatio 

Tickling 

9. 

Pruritus 

Itching 

10. 

Dolor  wens 

Smarting 

11. 

Consternatio 

Surprise 

• 

ORDO  II. 

Decreased  Irritation. 

GENUS  I. 

With  decreased  Actions  of  the  Sanguiferous  System. 

SPECIES. 

1. 

Febris  inirritativa 

Inirritative  fever 

2. 

Paresis  inirritativa 

debility 

3. 

Somnus  interruptus 

Interrupted  sleep 

4. 

Syncope 

Fainting 

5. 

Hcemorrhagia  venosa 

Venous  haemorrhage 

6. 

Hcemorrhois  cruenta 

Bleeding  piles 

7. 

Hcemorrhagia  renum 

from  the  kidneys 

8. 

1 LGUilL  to 

9. 

Hoemoptoe  venosa 

Spitting  of  venous  blood 

10. 

Palpitatio  cordis 

Palpitation  of  the  heart 

11. 

Menorrhagia 

Exuberant  menstruation 

12 

Dysrnenorrhagia 

Deficient  menstruation 

13. 

Lochia  nimia 

Too  great  lochia 

44. 

Abortio  spontanea 

Spontaneous  abortion 

Ci.ass  I.  2. 2. 


OF  IRRITATION. 


5 


15.  Scorbutus 

S curvy 

16.  Vibices 

Extravasations  of  blood 

17.  Petechice 

Purple  spots 

18.  Amerisma 

Aneurism 

1 9.  Vriax 

Swelling  of  veins 

GENUS  II. 

With  decreased  Actions  of  the  Secerning  System. 

1.  Frigus  febrile 

SPECIES. 

Coldness  in  fevers 

chronicum 

2.  Pallor  fugitivus 

permanent 

Paleness  fugitive 

permanens 

3.  Pus  parcius 

• permanent 

Diminished  pus 

4.  Mucus  parcior 

Diminished  mucus 

5.  Urina  parcior  pallida 

Pale  diminished  urine 

6.  Torpor  hepaticus 

Torpor  of  the  liver 

7.  Torpor  pancreatis 

Torpor  of  the  pancreas 

8.  Torpor  renis 

Torpor  of  the  kidney 

9.  Punctoe  mucosae  vultus 

Mucous  spots  on  the  face 

1 0.  Maculae  cutis  fulvoe 

Tawny  blots  on  the  skin 

1 1 . Canities 

Grey  hairs 

12.  Callus 

Callus 

13.  Cataracla 

Cataract 

14.  Innutritio  ossium 

Innutrition  of  the  bones 

15.  Rachitis 

Rickets 

16.  SpinoR  distortio 

Distortion  of  the  spine 

17.  Claudicatio  coxaria 

Lameness  of  the  hip 

18.  Spina  protuberans 

Protuberant  spine 

1 9.  Spina  bifida 

Divided  spine 

20.  Defectus  palati 

Defect  of  the  palate 

GENUS  III. 

With  decreased  Actions  of  the  Absorbent  System. 

SPECIES. 

Cold  mucus  from  the  throat 

sweat 

• catarrh 

expectoration 

Copious  pale  urine 
Cold  diarrhoea 

Fluor  albus 

gonorrhoea 


1.  Mucus  faucium  frigidus 

2.  Sudor  frigidus 

3.  Catarrhus  frigidus 

4.  Expectoralio frigida 

5.  Urina  uberior  pallida 

6.  Diarrhoea  frigida 

7.  Fluor  albus  frigidus 
3.  Gonorrhoea  frigida 


6 


DISEASES 


Class  I.  2.  4. 


9.  Hepatis  tumor 

1 0.  Chlorosis 

11.  Hydrocele 

12.  Hydrocephalus  internus 

13.  Ascite s 

1 4.  Hydrothorax 

15.  Hydrops  ovarii 

16.  Anasarca  pulmonum 

17.  Obesitas 

18.  Splenis  tumor 

1 9.  Genu  tumor  albus 

20.  Bronchocele 

21.  Scrofula 

22.  Scirrhus 


23. 

recti 

24. 

urethra 

25. 

oesophagi 

26.  Lacteorum  inirritabilitas 

27.  Lymphaticorum  inirritabi- 

litas 


Swelling  of  the  liver 

Green  sickness 

Dropsy  of  the  vagina  testis 

■ of  the  brain 

• of  the  belly 

of  the  chest 

of  the  ovary 

of  the  lungs 

Corpulency 

Swelling  of  the  spleen 

White  swelling  of  the  knee 

Swelled  throat 

King’s  evil 

Scirrhus 

of  the  rectum 

of  the  urethra 

of  the  throat 

Iniritability  of  the  lacteals 
Inirritability  of  the  lymphatics 


GENUS  IV. 

With  decreased  Actions  of  other  Cavities  and  Membranes 

SPECIES. 


1 . Sitis  ccdida 
frigida 

2.  Esuries 

8.  Nausea  sicca 

4.  JEgritudo  vcntriculi 

5.  Cardialgia 

6.  Arthritis  vcntriculi 

7.  Colica  Jlatulenta 

8.  Colica  saturnina 

9.  Tympanitis 

10.  Hypochondriasis 

1 1 . Cephalcea  idiopathica. 

12.  Hemicrania  idiopathica 

13.  Odontalgia 
Otalgia 

14.  Pleurodyne  chronicha 

1 5.  Sciatica  frigida 

16.  Lumbago  frigida 

1 7 . Hysteralgia  frigida 

18.  Proctalgia  frigida 


Thirst  warm 

cold 

Hunger 

Dry  nausea 

Sickness  of  stomach 

Heart-burn 

Gout  of  the  stomach 

Flatulent  colic 

Colic  from  lead 

Tympany 

Hypochondriacism 

Idiopathic  head-ach 

Idiopathic  hemicrania 

Tooth-ach 

Ear-ach 

Chronical  pain  of  the  side 
Cold  sciatica 

lumbago 

pain  of  the  uterus 

pain  of  the  rectum 


Class.  1. 3. 1. 


OF  IRRITATION. 


7 


19.  Vesicce  felloe,  inirritabilitas  Inirritability  of  the  gall  bladder 
et  icterus  and  jaundice 


GENUS  V. 

With  decreased  Actions  of  the  Organs  of  Sense. 
SPECIES. 


1. 

Stultitia  inirritabilis 

Folly  from  irritability 

2. 

Viscus  imminutus 

Impaired  vision 

3. 

Musc'oe  volitantes 

Dark  moving  specks 

4. 

Strabismus 

Squinting 

5. 

Amaurosis 

Palsy  of  the  optic  nerve 

6. 

Auditus  imminutus 

Impaired  hearing 

7. 

Olfaclus  imminutus 

• smell 

8. 

Gustus  imminutus 

taste 

9. 

Tactus  imminulus 

touch 

10. 

Stupor 

Stupor 

ORDO  III. 

Retrograde  Irritative  Motions. 
GENUS  I. 

Of  the  Alimentary  Canal. 
SPECIES. 


1.  Ruminatio 

2.  Ructus 

3.  Apepsia 

4.  Vomitus 

5.  Cholera 

6.  Ileus 

7.  Globus  hystericus 

8.  Vornendi  conamen  inane 

9.  Borborigmus 

10.  Hysteria 

11.  Hydrophobia 


Chewing  the  cud 
Eructation 

Indigestion,  water-qualm 
Vomiting 
Cholera 
Iliac  passion 
Hysteric  strangulation 
Vain  efforts  to  vomit 
Gurgling  of  the  bowels 
Hysteric  disease 
Dread  of  water 


GENUS  II. 

Of  the  Absorbent  System. 

SPECIES. 


1 . Catarrhus  lymphaticus 

2.  Salivatio  lymphatica 

3.  Nausea  humida 

4.  Diarrhoea  lymphatica 

5.  Diarrhoea  chylifera 


Lymphatic  catarrh 
Lymphatic  salivation 
Moist  nausea 
Lymphatic  flux 
Flux  of  chyle 


8 


DISEASES,  kc. 


Class  I.  3.  3. 


6.  Diabetes 

7.  Sudor  lymphaticus 

8.  Sudor  asthmaticus 

9.  Translatio  puris 

10.  lactis 

1 1 .  wince 


Diabetes 
Lymphatic  sweat 
Asthmatic  sweat 
Translation  of  matter 

of  milk 

of  urine 


GENUS  III. 

Of  the  Sanguiferous  System. 

SPECIES. 


1.  Capillarium  molus  retro-  Retrograde  motion  of  the  ca^ 

gressus  pillaries 

2.  Palpitalio  cordis  Palpitation  of  the  heart 

3.  Jlnhelatio  spasmodica  Spasmodic  panting 


Class  T.  I.  1. 


DISEASES,  &c. 


9 


CLASS  I. 

DISEASES  OF  IRRITATION, 

ORDO  I. 

Increased  Irritation. 

GENUS  I. 

With  increased  Actions  of  the  Sanguiferous  System, 

The  irritability  of  the  whole,  or  of  part  of  our  system  is  per* 
petually  changing;  these  vicissitudes  of  irritability  and  of  inirri- 
tability are  believed  to  depend  on  the  accumulation  or  exhaus- 
tion of  the  sensorial  power,  as  their  proximate  cause;  and  on  the 
difference  of  the  present  stimulus,  and  of  that  which  we  had 
previously  been  accustomed  to,  as  their  remote  cause.  Thus  a 
smaller  degree  of  heat  produces  pain  and  inflammation  in  our 
hands,  after  they  have  been  for  a time  immersed  in  snow; 
which  is  owing  to  the  accumulation  of  sensorial  power  in  the 
moving  fibres  of  the  cutaneous  vessels  during  their  previous  qui- 
escence, when  they  were  benumbed  with  cold.  And  we  feel 
ourselves  cold  in  the  usual  temperature  of  the  atmosphere  on 
coming  out  of  a warm  room;  which  is  owing  to  the  exhaustion 
of  sensorial  power  in  the  moving  fibres  of  the  vessels  of  the  skin 
by  their  previous  increased  activity,  into  which  they  were  excited 
by  unusual  heat. 

Hence  the  cold  fits  of  fever  are  the  occasion  of  the  succeeding 
hot  ones;  and  the  hot  fits  contribute  to  occasion  in  their  turn 
the  succeeding  cold  ones.  And  though  the  increase  of  stimulus, 
as  of  heat,  exercise,  or  distention,  will  produce  an  increased  ac- 
tion of  the  stimulated  fibres;  in  the  same  manner  as  it  is  produced 
bythe  increased  irritability  which  is  occasioned  by  a previous  de- 
fect of  stimulus;  yet  as  the  excesses  of  irritation  from  the  stimu- 
lus of  external  things  are  more  easily  avoided  than  the  deficien- 
cies of  it;  the  diseases  of  this  country,  except  those  which  are 
the  consequences  of  drunkenness,  or  of  immoderate  exercise, 
more  frequently  begin  with  torpor  than  with  orgasm;  that  is, 
with  inactivity  of  some  parts,  or  of  the  whole  of  the  system,  and 
consequent  coldness,  than  with  increased  activity,  and  conse- 
quent heat. 

If  the  hot  fit  be  the  consequence  of  the  cold  one,  it  may  be 
asked  if  they  are  proportionate  to  each  other?  it  is  probable  that 

VOL.  II.  c 


10 


DISEASES 


Class  I.  1.  1.  1 


they  are,  where  no  part  is  destroyed  by  the  cold  fit,  as  in  morti- 
fication or  death.  But  we  have  no  measure  to  distinguish  this, 
except  the  time  of  their  duration;  whereas  the  extent  of  the 
torpor  over  a greater  or  less  part  of  the  system,  which  occasions 
the  cold  fit;  or  of  the  exertion  which  occasions  the  hot  one;  as 
well  as  the  degree  of  such  torpor  or  exertion,  are  perhaps  more 
material  than  the  time  of  their  duration.  Besides  this,  some 
muscles  are  less  liable  to  accumulate  sensorial  power  during  their 
torpor,  than  others,  as  the  locomotive  muscles  compared  with 
the  capillary  arteries;  on  all  which  accounts  a long  cold  fit  may 
often  be  followed  by  a short  hot  one. 

As  the  torpor,  with  which  a fit  of  fever  commences,  is  some- 
times owing  to  defect  of  stimulus,  as  in  going  into  the  cold  bath; 
and  sometimes  to  a previous  exhaustion  of  the  sensorial  power 
by  the  action  of  some  violent  stimulus,  as  after  coming  out  of  a 
hot  room  into  cold  air;  a longer  time  must  elapse,  before  there 
can  be  a sufficient  accumulation  of  sensorial  power  to  produce  a 
hot  fit  in  one  case  than  in  the  other.  Because  in  the  latter  case 
the  quantity  of  sensorial  power  previously  expended  must  be 
supplied,  before  an  accumulation  can  begin. 

The  cold  paroxysm  commences,  when  the  torpor  of  a part  be- 
comes so  great,  and  its  motions  in  consequence  so  slow  or  feeble, 
as  not  to  excite  the  sensorial  power  of  association;  which  in 
health  contributes  to  move  the  rest  of  the  system,  which  is  cate- 
nated with  it.  And  the  hot  fit  commences  by  the  accumulation  of 
the  sensorial  power  of  irritation  of  the  part  first  affected,  either 
so  as  to  counteract  its  deficient  stimulus,  or  its  previous  waste  of 
sensorial  power;  and  it  becomes  general  by  the  accumulation  of 
the  sensorial  power  of  association;  which  is  excited  by  the  reno- 
vated actions  of  the  part  first  affected;  or  becomes  so  great  as  o 
overbalance  the  deficient  excitement  of  it.  On  all  these  accounts 
the  hot  fit  cannot  be  supposed  to  bear  any  proportion  to  the  cold 
one  in  length  of  time,  though  the  latter  may  be  the  consequence 
of  the  former.  See  Suppl.  I.  16.  S. 

SPECIES. 

1 . Febris  Irritalwa.  Irritative  fever.  This  is  the  synocha  of 
some  writers,  it  is  attended  with  strong  pulse  without  inflamma- 
tion; and  in  this  circumstance  differs  from  the  febris  iuirritativa 
of  Class  I.  2.  1.1.  which  is  attended  with  weak  pulse  without 
inflammation.  The  increased  frequency  of  the  pulsation  of  the 
heart  and  arteries  constitutes  fever;  during  the  cold  fit  these 
pulsations  are  always  weak,  as  the  energy  of  action  is  then  de- 
creased throughout  the  whole  system;  and  therefore  the  general 


Class  I.  1.1.  2. 


OF  IRRITATION. 


11 


arterial  strength  cannot  be  determined  by  the  touch,  till  the 
cold  part  of  the  paroxysm  ceases.  This  determination  is  some- 
times attended  with  difficulty;  as  strong  and  weak  are  only  com- 
parative degrees  of  the  greater  or  less  resistance  of  the  pulsation 
of  the  artery  to  the  compression  of  the  finger.  But  the  greater 
or  less  frequency  of  the  pulsations  affords  a collateral  evidence 
in  those  cases,  where  the  degree  of  strength  is  not  very  distin- 
guishable, which  may  assist  our  judgment  concerning  it.  Since 
a moderately  strong  pulse,  when  the  patient  is  in  a recumbent 
posture,  and  not  hurried  in  mind,  seldom  exceeds  120  strokes  in 
a minute;  whereas  a weak  one  often  exceeds  130  in  a recum- 
bent posture,  and  150  in  an  erect  one,  in  those  fevers,  which  are 
termed  nervous  or  putrid.  See  Sect.  XII.  1.  4. 

The  increased  frequency  of  the  pulsation  of  the  heart  and  ar- 
teries, as  it  is  occasioned  either  by  excess  or  defect  of  stimulus,  or 
of  sensorial  power,  exists  both  in  the  cold  and  hot  fits  of  fever; 
but  when  the  cold  fit  ceases,  and  the  pulse  becomes  strong  and 
full  as  well  as  quick,  in  consequence  of  the  increased  irritability 
of  the  heart  and  arteries,  it  constitutes  the  irritative  fever,  or  sy- 
nocha.  It  is  attended  with  considerable  heat  during  the  paroxysm, 
and  generally  terminates  in  a quarter  of  a lunation,  without  any 
disturbance  of  the  faculties  of  the  mind.  See  Class  IV.  1.1.8. 

M.  M.  Venesection.  Emetics.  Cathartics.  Cool  (he  patient 
in  the  hot  fit,  and  warm  him  in  the  cold  one.  Rest.  Torpentia. 

2.  Ebrietas.  Drunkenness.  By  the  stimulus  of  wine  or  opium 
the  whole  arterial  system,  as  well  as  every  other  part  of  the  moving 
system,  is  excited  into  increased  action.  All  these  secretions,  and 
with  them  the  production  of  sensorial  power  itself  in  the  brain, 
seem  to  be  for  a time  increased,  with  an  additional  quantity  of  heat, 
and  of  pleasurable  sensation.  See  Sect.  XXL  on  this  subject. 
This  explains  why  at  the  commencement  of  the  warm  paroxysm 
of  some  fevers  the  patient  is  in  greater  spirits,  or  vivacity;  because, 
as  in  drunkenness,  the  irritative  motions  are  all  increased,  and  a 
greater  production  of  sensation  is  the  consequence,  which,  when 
in  a certain  degree,  is  pleasurable,  as  in  the  diurnal  fever  of  weak 
people.  Sect.  XXXVI.  3.  1. 

3.  Hcemorrhagia  arteriosa.  Arterial  haemorrhages.  Bleeding, 
with  a quick,  strong,  and  full  pulse.  The  haemorrhages  from 
the  lungs,  and  from  the  nose,  are  the  most  frequent  of  these;  but 
it  sometimes  happens,  that  a small  artery  but  half  divided,  or  the 
puncture  of  a leech  will  continue  to  bleed  pertinaciously. 

M.  M.  Venesection.  Cathartic  with  calomel.  Divide  the 
wounded  artery.  Bind  sponge  on  the  puncture.  If  coffee  or 
charcoal,  internally?  If  air,  with  less  oxygene? 

4 Hcemoptoe  arteriosa.  Spitting  of  arterial  blood.  Blood  spit 


12 


DISEASES 


Class  1. 1.  1.  5. 


up  from  the  lungs  is  florid,  because  it  has  just  been  exposed  to  the 
influence  of  the  air  in  its  passage  through  the  extremities  of  the 
pulmonary  artery;  it  is  frothy,  from  the  admixture  of  air  with  it 
in  the  bronchia.  The  patients  frequently  vomit  at  the  same  time 
from  the  disagreeable  titillalion  of  blood  about  the  fauces;  and  are 
thence  liable  to  believe,  that  the  blood  is  ejected  from  the  stomach. 

Sometimes  an  haemoptoe  for  several  successive  days  returns  in 
gouty  persons  without  danger,  and  seems  to  supply  the  place  of 
the  gouty  paroxysms.  Is  not  the  liver  always  diseased  previous 
to  the  haemoptoe,  as  in  several  other  haemorrhages?  See  Class 
I.  2.  1.  9. 

M.  M.  Venesection,  a purge,  a blister,  diulents,  torpentia; 
and  afterwards  sorbentia,  as  the  bark,  the  acid  of  vitriol,  and 
opium.  An  emetic  is  said  to  stop  a pulmonary  haemorrhage, 
which  it  may  effect,  as  sickness  decreases  the  circulation,  as  is 
very  evident  in  the  great  sickness  sometimes  produced  by  too  large 
a dose  of  digitalis  purpurea. 

Dr.  Rush  says,  a table-spoonful  of  or  two  of  common  salt  is  suc- 
cessful in  haemoptoe;  this  may  be  owing  to  its  stimulating  the 
absorbent  systems,  both  the  lymphatic,  and  the  venous.  Should 
the  patient  respire  air  with  less  oxygen?  or  be  made  sick  by 
whirling  round  in  a chair  suspended  by  a rope?  One  immer- 
sion in  cold  water,  or  a sudden  sprinkling  all  over  with  cold 
water,  would  probably  stop  a pulmonary  haemorrhage.  See  Sect. 
XXVII.  1. 

5.  Hazmorrhagiu  ncirium.  Epistaxis.  Bleeding  at  the  nose  in 
elderly  subjects  most  frequently  attends  those,  whose  livers  are 
enlarged  or  inflamed  by  the  too  frequent  use  of  fermented  liquors. 

In  boys  it  occurs  perhaps  simply  from  redundancy  of  blood; 
and  in  young  girls  sometimes  precedes  the  approach  of  the  cata- 
menia; and  then  it  shews  a disposition  contrary  to  chlorosis; 
which  arises  from  a deficiency  of  red  blood. 

M.  M.  It  is  stopped  by  plunging  the  head  into  cold  water, 
with  powdered  salt  hastily  dissolved  in  it;  or  sometimes  by  lint 
strewed  over  with  wheat  flour  put  up  the  nostrils;  or  by  a so- 
lution of  steel  in  brandy  applied  to  the  vessel  by  means  of  lint. 
The  cure  in  other  respects  as  in  haemoptoe;  when  the  bleeding 
recurs  at  certain  periods,  after  venesection,  and  evacuation  by 
calomel,  and  a blister,  the  bark  and  steel  must  be  given,  as  in 
intermittent  fevers.  See  Sect.  XXVII.  1. 

The  tincture  of  digitalis  given  in  proper  quantities,  as  30  drops 
from  a two-ounce  phial  every  six  hours  for  two  or  three  or  four 
doses,  is  probably  an  efficacious  medicine.  See  Dr.  Ferriar’s 
Treatise  on  Digitalis.  He  stopped  active  haemorrhages  by  the 
exhibition  of  digitalis. 


Class  I.  1.  2. 1. 


OF  IRRITATION. 


13 

ORDO  I. 

Increased  Irritation, 

GENUS  II. 

With  increased  Actions  of  the  Secerning  System. 

These  are  always  attended  with  increase  of  partial  or  of  gene- 
ral heat;  for  the  secreted  fluids  are  not  simply  separated  from 
the  blood,  but  are  new  combinations;  as  they  did  not  previously 
exist  as  such  in  the  blood-vessels.  But  all  new  combinations  give 
out  heat  chemically;  hence  the  origin  of  animal  heat,  which 
is  always  increased  in  proportion  to  the  secretion  of  the  part 
affected,  or  to  the  general  quantity  of  the  secretions.  Neverthe- 
less there  is  reason  to  believe,  that  as  we  have  a sense  purposely 
to  distinguish  the  presence  of  greater  or  less  quantities  of  heat, 
as  mentioned  in  Sect.  XIV.  6.  so  we  may  have  certain  minute 
glands  for  the  secretion  of  this  fluid,  as  the  brain  is  believed  to 
secrete  the  sensorial  power,  which  would  more  easily  account  for 
the  instantaneous  production  of  the  blush  of  shame,  and  of  an- 
ger. This  subject  deserves  further  investigation. 

SPECIES. 

1.  Calorfebrilis.  The  heat  in  fevers  arises  from  the  increase 
of  some  secretion,  either  of  the  natural  fluids,  as  in  irrita- 
tive fevers;  or  of  new  fluids,  as  in  infectious  fevers;  or  of  new 
vessels,  as  in  inflammatory  fevers.  The  pain  of  heat  is  a conse- 
quence of  the  increased  extension  or  contraction  of  the  fibres 
exposed  to  so  great  a stimulus.  See  Class  I.  1.5.  6. 

2.  Rubor  febrilis.  Febrile  redness.  When  the  cold  fit  of  fe- 
ver terminates,  and  the  pulsations  of  the  heart  and  arteries  be- 
come strong  as  well  as  quick  from  the  increase  of  their  irritabili- 
ty after  their  late  quiescence,  the  blood  is  impelled  forwards  in- 
to the  fine  extremities  of  the  arteries,  and  the  anastamosing  ca- 
pillaries, quicker  than  the  extremities  of  the  veins  can  absorb 
and  return  it  to  the  heart.  Hence  the  pulse  at  the  wrist  becomes 
full,  as  well  as  quick  and  strong,  and  the  skin  glows  with  arte- 
rial blood,  and  the  veins  become  empty  and  less  visible. 

In  elderly  people  the  force  of  the  heart  and  arteries  becomes 
less,  while  the  absorbent  power  of  the  veins  remains  the  same; 
whence  the  capillary  vessels  part  with  the  blood,  as  soon  as  it  is 
received,  and  the  skin  in  consequence  becomes  paler;  it  is  also 


14 


DISEASES 


Class  I.  1.  2-  3*  ' 

probable,  that  in  more  advanced  life  some  of  the  finer  branches 
of  the  ar'eries  coalesce,  and  become  impervious,  and  thus  add 
to  the  opacity  of  the  skin. 

3.  Sudor  calidus.  Warm  sweat  may  be  divided  into  four  va- 
rieties, according  to  its  remote  causes.  First,  the  perspirable 
matter  is  secreted  in  as  great  quantity  during  the  hot  fit  of  fever, 
as  towards  the  end  of  it,  when  the  sweat  is  seen  upon  the  skin. 
But  during  the  hot  fit  the  cutaneous  absorbents  act  also  with  in- 
creased energy,  and  the  exhalation  is  likewise  increased  by  the 
greater  heat  of  the  skin;  and  hence  it  does  not  appear  in  drops 
on  the  surface,  but  is  in  part  re-absorbed,  and  in  part  dissipated 
in  the  atmosphere.  But  as  the  mouths  of  the  cutaneous  absorb- 
ents are  exposed  to  the  cool  air  or  bed  clothes;  whilst  those  of 
the  capillary  glands,  which  secrete  the  perspirable  matter  are  ex- 
posed to  the  warmth  of  the  circulating  blood;  the  former,  as 
soon  as  the  fever-fit  begins  to  decline,  lose  their  increased  action 
first,  and  hence  the  absorption  of  the  sweat  is  diminished^ 
whilst  the  increased  secretion  of  it  continues  for  some  hours  af- 
terwards, which  occasions  it  to  stand  in  drops  upon  the  skin. 

As  the  skin  becomes  cooler,  the  evaporation  of  the  perspira- 
ble matter  becomes  less,  as  well  as  the  absorption  of  it.  And 
hence  the  dissipation  of  aqueous  fluid  from  the  body,  and  the 
consequent  thirst,  are  perhaps  greater  during  the  hot  fit,  than 
during  the  subsequent  sweat.  For  the  sweats  do  not  occur,  ac- 
cording to  Dr.  Alexander’s  experiments,  till  the  skin  is  cooled 
from  112  to  108  degrees  of  heat;  that  is  till  the  paroxysm  be- 
gins to  decline.  From  this  it  appears,  that  the  sweats  are  not 
critical  to  the  hot  fit  any  more  than  the  hot  fit  can  be  called 
critical  to  the  cold  one;  but  simply,  that  they  are  the  natural 
consequence  of  the  decline  of  the  hot  fit  commencing  with  the 
decreased  action  of  the  absorbent  system,  and  the  decreased  eva- 
poration from  the  skin.  And  from  hence  it  may  be  concluded, 
that  a fever-fit  is  not  in  general  an  effort  of  nature  to  restore 
health,  as  Sydenham  considered  it,  but  a necessary  consequence 
of  the  previous  torpor;  and  that  the  causes  of  fevers  would  be 
less  detrimental,  if  the  fever  itelf  could  be  prevented  from  ex- 
isting; as  appears  in  the  cool  treatment  of  the  small-pox. 

It  must  be  noted  that  the  profuse  sweats  on  the  skin  are  more 
frequent  at  the  decline  of  fever-fits  than  the  copious  urine,  or 
loose  stools,  which  are  mentioned  below;  as  the  cutaneous  ab- 
sorbents, being  exposed  to  the  cool  air,  lo#se  their  increased  ac- 
tion sooner  than  the  urinary  or  intestinal  absorbents;  which 
open  into  the  warm  cavities  of  the  bladder  and  intestines;  but 
which  are  nevertheless  often  affected  by  their  sympathy  with  the 
cutaneous  absorbents.  Hence  few  fevers  terminate  without  a 


Class.  I.  1.  2.  3. 


OF  IRRITATION. 


15 


moisture  of  the  skin;  whence  arose  the  fatal  practice  of  forcing 
sweats  by  the  external  warmth  of  air  or  bed-clothes  in  fevers; 
for  external  warmth  increases  the  action  of  the  cutaneous  capil- 
laries more  than  that  of  the  other  secerning  vessels;  because  the 
latter  are  habituated  to  98  degrees  of  heat,  the  internal  warmth  of 
the  body;  whereas  the  cutaneous  capillaries  being  nearer  the  sur- 
face are  habitually  kept  cooler  by  the  contact  of  the  external  air. 
Sweats  thus  produced  by  heat  in  confined  rooms  are  still  more 
detrimental;  as  the  air  becomes  then  not  only  deprived  of  a part 
of  its  oxygene  by  frequent  respiration,  but  is  loaded  with  animal 
effluvia  as  well  as  with  moisture,  till  it  can  receive  no  more;  and 
in  consequence,  while  the  cutaneous  secretion  stands  upon  the 
skin  in  drops  for  want  of  exhalation,  the  lungs  are  exposed  to  an 
insalubrious  atmosphere. 

I do  not  deny,  that  sweating  may  be  so  managed  as  to  be 
serviceable  in  preventing  the  return  of  the  cold  paroxysm  of  fevers ; 
like  the  warm  bath,  or  any  other  permant  stimulus,  as  wine,  or 
opium,  or  the  bark.  For  this  purpose  it  should  be  continued 
till  past  the  time  of  the  expected  cold  fit,  supported  by  moderate 
doses  of  wine-whey,  with  spirit  of  hartshorn,  and  moderate  de- 
grees of  warmth.  Its  salutary  effect,  when  thus  managed,  was 
probably  one  cause  of  its  having  been  so  much  attended  to;  and 
the  fetid  smell,  which  when  profuse  is  liable  to  accompany  it, 
gave  occasion  to  the  belief,  that  the  supposed  material  cause  of 
the  disease  was  thus  eliminated  from  the  circulation. 

When  too  great  external  heat  is  applied,  the  system  is  weak- 
ened by  excess  of  action,  and  the  torpor  which  causes  the  cold 
paroxysm  recurs  sooner  and  more  violently.  For  though  some 
stimuli,  as  of  opium  and  alcohol,  at  the  same  time  that  they  ex- 
haust the  sensorial  power  by  promoting  increase  of  fibrous  action, 
may  also  increase  the  production  or  secretion  of  it  in  the  brain, 
yet  experience  teaches  us  that  the  exhaustion  far  out-balances  the 
increased  production,  as  is  evinced  by  the  general  debility,  which 
succeeds  intoxication. 

In  respect  to  the  fetor  attending  copious  continued  sweats,  it 
is  owing  to  the  animalized  part  of  this  fluid  being  kept  in  that  de- 
gree of  warmth,  which  most  favours  putrefaction,  and  not  suf- 
fered to  exhale  into  the  atmosphere.  Broth,  or  other  animal 
mucus,  kept  in  similar  circumstances,  would  in  the  same  time 
acquire  a putrid  smell;  yet  has  this  error  frequently  produced 
miliary  eruptions,  and  increased  every  kind  of  inflammatory  or 
sensitive  fever. 

The  ease,  which  the  patient  experiences  during  sweating,  if 
it  be  not  produced  by  much  external  heat,  is  similar  to  that  of 
the  w7arm  bath;  which  by  its  stimulus  appU.d  to  the  cutaneous 


16 


DISEASES 


Class  I.  1.  2.  3. 

vessels,  which  are  generally  cooler  than  the  internal  parts  of  the 
system,  excites  them  into  greater  action;  and  pleasurable  sensa- 
tion is  the  consequence  of  these  increased  actions  of  the  vessels 
of  the  skin.  From  considering  all  these  circumstances,  it  ap- 
pears that  it  is  not  the  evacuation  by  sweats,  but  the  continued 
stimulus,  which  causes  and  supports  those  sweats  which  is  ser- 
viceable in  preventing  the  returns  of  fever-fits.  And  that  sweats 
too  long  continued,  or  induced  by  too  great  stimulus  of  warmth, 
clothes,  or  medicines,  greatly  injure  the  patient  by  increasing  in- 
flammation, or  by  exhausting  the  sensorial  power.  See  Class  I. 
1.  2.  14. 

Secondly , The  sweats  produced  by  exercise  or  labour  are  of 
the  warm  kind;  as  they  originate  from  the  increased  action  of 
the  capillaries  of  the  skin,  owing  to  their  being  more  powerfully 
stimulated  by  the  greater  velocity  of  the  blood,  and  by  a greater 
quantity  of  it  passing  through  them  in  a given  time.  For  the 
blood  during  violent  exercise  is  carried  forwards  by  the  action 
of  the  muscles  faster  in  the  arteries,  than  it  can  be  taken  up  by 
the  veins;  as  appears  by  the  redness  of  the  skin.  And  from 
the  consequent  sweats,  it  is  evinced,  that  the  secretory  vessels 
of  the  skin  during  exercise  pour  out  the  perspirable  matter  faster, 
than  the  mouths  of  the  absorbent  vessels  can  drink  it  up.  Which 
mouths  are  not  exposed  to  the  increased  muscular  action,  or  to 
the  stimulus  of  the  increased  velocity  and  quantity  of  the  blood, 
but  to  the  cool  air. 

Thirdly,  The  increased  secretion  of  perspirable  matter  occasion- 
ed by  the  stimulus  of  external  heat  belongs  likewise  to  this  place; 
as  it  is  caused  by  the  increased  motions  of  the  capillary  vessels: 
which  thus  separate  from  the  blood  more  perspirable  matter, 
than  the  mouths  of  their  correspondent  absorbent  vessels  can  take 
up;  though  these  also  are  stimulated  by  external  heat  into  more 
energetic  action.  If  the  air  be  stationary,  as  in  a small  room, 
or  bed  with  closed  curtains,  the  sweat  stands  in  drops  on  the  skin 
for  want  of  a quicker  exhalation  proportioned  to  the  quicker  se- 
cretion. 

A fourth  variety  of  warm  perspiration  is  that  occasioned  by 
stimulating  drugs,  of  which  opium  and  alcohol  are  the  most 
powerful;  and  next  to  these  the  spices,  volatile  alkali,  and  neu- 
tral salts,  especially  sea-salt;  that  much  of  the  aqueous  part  of 
the  blood  is  dissipated  by  the  use  of  these  drugs,  is  evinced  by 
the  great  thirst,  which  occurs  a few  hours  after  the  use  of  them. 
See  Art.  III.  2.  1. 

We  may  from  hence  understand,  that  the  increase  of  this 
secretion  of  perspirable  matter  by  artificial  means,  must  be  fol- 
lowed by  debility  and  emaciation.  When  this  is  done  by  taking 


OF  IRRITATION. 


17 


Class  I.  1.  2.  3. 


much  salt,  or  salted  meat,  the  sea-scurvy  is  produced;  which 
consists  in  the  irritability  of  the  bibulous  terminations  of  the 
veins  arising  from  the  capillaries;  see  Class  I.  2.  1.  14.  The 
scrofula,  or  inirritability  of  the  lymphatic  glands,  seems  also  to  be 
occasionally  induced  by  an  excess  in  eating  salt  added  to  food  of 
bad  nourishment.  See  Class  I.  2.  3.  21.  If  an  excess  of  per- 
spiration is  induced  by  warm  or  stimulant  clothing,  as  by  wear- 
ing flannel  in  contact  with  the  skin  in  the  summer  months,  a per- 
petual febricula  is  excited,  both  by  the  preventing  the  access  of 
cool  air  to  the  skin,  and  by  perpetually  goading  it  by  the  nume- 
rous and  hard  points  of  the  ends  of  the  wool;  which  when  ap- 
plied to  the  tender  skins  of  young  children,  frequently  produce 
the  red  gum,  as  it  is  called;  and  in  grown  people,  either  an 
erysipelas,  or  a miliary  eruption,  attended  with  fever.  See 
Class  II.  1.  3.  12. 

Shirts  made  of  cotton  or  calico  stimulate  the  skin  too  much 
by  the  points  of  the  fibres,  though  less  than  flannel;  whence 
cotton  handkerchiefs  make  the  nose  sore  by  frequent  use.  The 
fibres  of  cotton  are,  I suppose,  ten  times  shorter  than  those  of 
flax,  and  the  number  of  points  in  consequence  twenty  times  the 
number;  and  though  the  manufacturers  singe  their  calicoes  on 
a red-hot  iron  cylinder,  yet  I have  more  than  once  seen  an  ery- 
sipelas induced  or  increased  by  the  stimulus  of  calico,  as  well  as 
of  flannel;  and  have  during  the  last  summer  prevailed  on  two 
who  were  confined  to  their  beds  by  fevers,  and  three,  who  were 
in  a state  of  great  debility,  to  disencumber  themselves  of  the 
flannel  shirts  which  they  had  worn  for  some  time;  all  of  them 
became  immediately  and  considerably  relieved;  and  found  no 
inconvenience  afterwards  by  discontinuing  an  unnecessary  sti- 
mulus, which  had  nothing  to  recommend  it  to  those  patients  but 
the  frivolous  fashion  of  the  day. 

The  inconvenience,  which  weak  constitutions  experience  from 
wearing  flannel  shirts,  arises  from  this  circumstance;  that  the  ex- 
tremities of  their  limbs  are  more  liable  to  become  cold,  than  the 
surface  of  the  chest  and  abdomen,  and  that  hence  they  should  in 
preference  wear  warmer  stockings,  shoes,  and  socks,  or  gloves. 
By  stimulating  the  warmer  parts  of  the  skin  into  too  strong  and 
useless  exertion,  as  by  the  hard  points  of  a flannel  shirt  at  all  sea- 
sons, and  by  its  confining  the  warmth  of  the  skin  too  much  in 
the  summer  months,  a part  of  the  sensorial  power  becomes  un- 
necessarily expended;  and  in  weak  constitutions,  where  there  is 
none  to  spare,  some  other  parts  of  the  system  must  act  with  less 
■energy;  and  thus  I believe  the  extremities  of  feeble  people  be- 
come colder  by  the  use  of  a flannel  shirt;  in  stronger  people,  and 
perhaps  in  warmer  climates,  this  increased  coldness  of  the  ex- 

VOL.  II.  d 


IS 


DISEASES 


Class  I.  1.  2.3. 


tremities  may  not  be  perceptible;  as  stronger  persons  can  better 
bear  some  increased  exertion,  and  the  consequent  unnecessary 
loss  of  some  sensorial  power;  and  in  warmer  climates  the  ex- 
tremities may  not  be  so  liable  to  become  cold. 

Analogous  to  this  I remember  to  have  seen  an  inoculated  child 
about  six  years  old,  whose  bosom  and  face,  at  the  beginning  of  the 
eruptive  fever  were  of  a fiery  red  colour,  and  exceedingly  hot  to 
the  touch;  and  whose  feet  were  at  the  same  time  pale,  and  cold 
to  the  touch.  When  on  exposing  the  bosom  and  face  to  colder 
air  with  the  feet  only  slightly  covered,  the  colour  of  the  former  in 
a few  minutes  became  nearly  natural,  with  little  excess  of  tangi- 
ble heat,  and  at  the  same  time  the  feet  became  as  warm  as  natural. 

Whence  I conclude,  that  all  unnecessary  increase  of  stimuli,  as 
of  warm  clothing,  wine,  and  opium,  is  more  injurious  to  fee- 
ble constitutions  than  to  robust  ones;  and  that  such  stimuli  alone 
are  salutary  to  weak  persons,  as  increase  those  actions  of  the  sys- 
tem, which  are  immediately  necessary  to  life  and  health,  as  the 
class  of  medicines  termed  sorbentia,  as  peruviau  bark,  and  other 
bitters,  and  very  small  quantities  of  steel,  as  these  seem  to  increase 
the  activity  of  the  absorbent  system,  both  of  the  lymphatic  and 
venous  ones,  and  thus  supply  more  nutrition,  with  all  its  salutary 
consequences.  And  that  the  use  of  these  sorbentia,  as  w'ell  as 
of  the  occasional  use  of  warmer  clothing,  wine,  and  opium, 
should  be  discontinued,  as  soon  as  the  system  can  acquire  the 
natural  habit  of  acting  with  sufficient  energy  without  them.  See 
Article  II.  2.  2.1.  of  the  Materia  Medica. 

The  increase  of  perspiration  by  beat  either  of  clothes,  or  of  fire, 
contributes  much  to  emaciate  the  body;  as  is  well  known  to  jock- 
eys, who,  when  they  are  a stone  or  two  too  heavy  for  riding, 
find  the  quickest  way  to  lessen  their  weight  is  by  sweating  them- 
selves between  blankets  in  a warm  room;  but  this  likewise  is  a 
practice  by  no  means  to  be  recommended,  as  it  weakens  the  sys- 
tem by  the  excess  of  so  general  a stimulus,  brings  on  a premature 
old  age,  and  shortens  the  span  of  life;  as  may  be  further  deduced 
from  the  quick  maturity,  and  shortness  of  the  lives,  of  the  inhabi- 
tants of  Hindostan,  and  other  tropical  climates. 

When  the  heat  of  the  body  in  weak  patients  in  fevers  is  in- 
creased by  the  stimulus  of  the  points  of  flannel,  a greater  conse- 
quent debility  succeeds,  than  when  it  is  produced  by  the  warmth 
of  fire;  as  in  the  former  the  heat  is  in  part  owing  to  the  increas- 
ed activity  of  the  skin,  and  consequent  expenditure  of  sensorial 
power;  whereas  in  the  latter  case  it  is  in  part  owing  to  the 
influx  of  the  fluid  matter  of  heat. 

So  the  warmth  produced  by  equitation,  or  by  rubbing  the  body 
and  limbs  with  a smooth  brush  or  hand,  as  is  done  after  bathing 


Glass.  I.  1.  2.  4. 


OF  IRRITATION. 


19 


in  some  parts  of  the  East,  does  not  expend  nearly  so  much  sen- 
sorial power,  as  when  the  warmth  is  produced  by  the  locomo- 
tion of  the  whole  weight  of  the  body  by  muscular  action,  as  in 
walking,  or  running,  or  swimming.  Whence  the  warmth  of  a 
fire  is  to  be  preferred  to  flannel  shirts  for  weak  people,  and  the 
agitation  of  a horse  to  exercise  on  foot.  And  I suppose  those, 
who  are  unfortunately  lost  in  snow,  who  are  on  foot,  are  liable 
to  perish  sooner  by  being  exhausted  by  their  muscular  exertions; 
and  might  frequently  preserve  themselves  by  lying  on  the  ground 
and  covering  themselves  with  snow,  before  they  were  too  much 
exhausted  by  fatigue.  See  Botan.  Garden,  Vol.  II.  the  note  on 
Barometz. 

M.  Button  made  a curious  experiment  to  shew  this  circum- 
stance. He  took  a numerous  brood  of  the  butterflies  of  silk- 
worms, some  hundreds  of  which  left  their  eggs  on  the  same  day 
and  hour;  these  he  divided  into  two  parcels;  and  placing  one  par- 
cel in  the  south  window,  and  the  other  in  the  north  window  of  his 
house,  he  observed,  that  those  in  the  colder  situation  lived  many 
days  longer  than  those  in  the  warmer  one.  From  these  observa- 
tions it  appears,  that  the  wearing  of  flannel  clothing  next  the 
skin,  which  is  now  so  much  in  fashion,  however  useful  it  may 
be  in  the  winter  to  those,  who  have  cold  extremities,  bad  diges- 
tions, or  habitual  coughs,  must  greatly  debilitate  them,  if  worn 
in  the  warm  months,  producing  fevers,  eruptions,  and  premature 
old  age.  See  Sect.  XXXVII.  5.  Class  I.  1.  2.  14.  Art.  III.  2.  1. 

4.  Urina  uberior  colorata.  Copious  coloured  urine.  To- 
wards the  end  of  fever-fits  a large  quantity  of  high  coloured 
urine  is  voided,  the  kidneys  continuing  to  act  strongly,  after  the 
increased  action  of  the  absorbents  of  the  bladder  is  somewhat 
diminished.  If  the  absorbents  continue  also  to  act  strongly,  the 
urine  is  higher  coloured,  and  so  loaded  as  to  deposit,  when  cool, 
an  earthy  sediment,  erroneously  thought  to  be  the  material  cause 
of  the  disease;  but  is  simply  owing  to  the  secretion  of  the  kidneys 
being  great  from  their  increased  action;  and  the  thinner  parts 
of  it  being  absorbed  by  the  increased  action  of  the  lymphatics, 
which  are  spread  very  thick  on  the  neck  of  the  bladder;  for  the 
urine,  as  well  as  perhaps  all  the  other  secreted  fluids,  is  produced 
from  the  kidneys  in  a very  dilute  state;  as  appears  in  those, 
who  from  the  stimulus  of  a stone,  or  other  cause,  evacuate  their 
urine  too  frequently;  which  is  then  pale  from  its  not  having 
remained  in  the  bladder  long  enough  for  the  more  aqueous  part 
to  have  been  re-absorbed.  The  general  use  of  this  urinary  ab- 
sorption to  the  animal  economy  is  evinced  from  the  urinary  blad- 
ders of  fish,  which  would  otherwise  be  unnecessary.  High  co- 
loured urine  in  large  quantity  shew's  only,  that  the  secreting  ves- 


20 


DISEASES 


Class-  I.  1.2.  5. 


sels  of  the  kidneys,  and  the  absorbents  of  the  bladder,  have  acted 
with  greater  energy.  When  there  is  much  earthy  sediment,  it 
shews  that  the  absorbents  have  acted  proportionally  stronger, 
and  have  consequently  left  the  urine  in  a less  dilute  state.  Iu 
this  urine  the  transparent  sediment  or  cloud  is  mucous;  the 
opaque  sediment  is  probably  coagulable  lymph  from  the  blood 
changed  by  an  animal  or  chemical  process.  The  floating  scum 
is  oil.  The  angular  concretions  to  the  sides  of  the  pot,  formed 
as  the  urine  cools,  is  microcosmic  salt.  Does  the  adhesive  blue 
matter  on  the  sides  of  the  glass,  or  the  blue  circle  on  it  at  the 
edge  of  the  upper  surface  of  the  urine,  consist  of  Prussian  blue? 

5.  Diarrhoea  calida.  Warm  Diarrhoea.  This  species  may  be 
divided  into  three  varieties,  deduced  from  their  remote  causes, 
under  the  names  of  diarrhoea  febrilis,  diarrhoea  crapulosa,  and 
diarrhoea  infantum.  The  febrile  diarrhoea  appears  at  the  end 
of  fever  fits,  and  is  erroneously  called  critical,  like  the  copious 
urine,  and  the  sweats;  whereas  it  arises  from  the  increased  ac- 
tion of  those  secerning  organs,  which  pour  their  fluids  into  the 
intestinal  canal,  (as  the  liver,  pancreas,  and  mucous  glands,) 
continuing  longer  than  the  increased  action  of  the  intestinal  ab- 
sorbents. In  this  diarrhoea  there  is  no  appearance  of  curdled 
chyle  in  the  stools,  as  occurs  in  cholera.  I.  3.  1.  5. 

The  diarrhoea  crapulosa , or  diarrhoea  from  indigestion,  occurs 
when  too  great  a quantity  of  food  or  liquid  has  been  taken: 
which  not  being  completely  digested,  stimulates  the  intestines 
like  any  other  extraneous  acrid  material;  and  thus  produces  an 
increase  of  the  secretions  into  them  of  mucus,  pancreatic  juice, 
and  bile.  When  the  contents  of  the  bowels  are  still  more  stimu- 
lant, as  when  drastic  purges,  or  very  putrescent  diet,  have  been 
taken,  a cholera  is  induced.  See  Sect.  XXIX.  4. 

The  diarrhoea  infantum , or  diarrhoea  of  infants,  is  generally 
owing  to  too  great  acidity  in  their  bowels.  Milk  is  found 
curdled  in  the  stomachs  of  all  animals,  old  as  well  as  young,  and 
even  of  carnivorous  ones,  as  of  hawks.  (Spallanzani.)  And 
it  is  the  gastric  juice  of  the  calf,  which  is  employed  to  curdle 
milk  in  the  process  of  making  cheese.  Milk  is  the  natural  food 
for  children,  and  must  curdle  in  their  stomachs  previous  to  di- 
gestion; and  as  this  curdling  of  the  milk  destroys  a part  of  the 
acid  juices  of  the  stomach,  there  is  no  reason  for  discontinuing 
the  use  of  it,  though  it  is  occasionally  ejected  in  a curdled  state. 
A child  of  a week  old,  which  had  been  taken  from  the  breast  of 
its  dying  mother,  and  had  by  some  uncommon  error  been  suf- 
fered to  take  no  food  but  water-gruel,  became  sick  and  griped 
in  twenty-four  hours,  and  was  convulsed  on  the  second  day,  and 
died  on  the  third?  When  all  young  quadrupeds,  as  well  as 


Class  I.  1.  2.  6. 


OF  IRRITATION. 


21 


children,  have  this  natural  food  of  milk  prepared  for  them,  the 
analogy  is  so  strong  in  favour  of  its  salubrity,  that  a person 
should  have  powerful  testimony  indeed  of  its  disagreeing  before 
he  advises  the  discontinuance  of  the  use  of  it  to  young  children 
in  health,  and  much  more  so  in  sickness.  The  farmers  lose  many 
of  their  calves,  which  are  brought  up  by  gruel,  or  gruel  and  old 
milk;  and  among  the  poor  children  of  Derby,  who  are  thus  fed, 
hundreds  are  starved  into  the  scrofula,  and  either  perish  or  live 
in  a state  of  wretched  debility. 

When  young  children  are  brought  up  without  a breast,  they 
should  for  the  first  two  months  have  no  food  but  new  milk; 
since  the  addition  of  any  kind  of  bread  or  flour  is  liable  to  fer- 
ment, and  produce  too  much  acidity;  as  appears  by  the  conse- 
quent diarrhoea  with  green  dejections  and  gripes;  the  colour  is 
owing  to  a mixture  of  acid  with  the  natural  quantity  of  bile,  and 
the  pain  to  its  stimulus.  And  they  should  never  be  fed  as  they 
lie  upon  their  backs,  as  in  that  posture  they  are  necessitated  to 
swallow  all  that  is  put  into  their  mouths;  but  when  they  are  fed, 
as  they  are  sitting  up,  or  raised  up,  when  they  have  had  enough, 
they  can  permit  the  rest  to  run  out  of  their  mouths.  This  cir- 
cumstance is  of  great  importance  to  the  health  of  those  children, 
who  are  reared  by  the  spoon,  since  if  too  much  food  is  given 
them,  indigestion,  and  gripes,  and  diarrhoea,  are  the  consequence; 
and  if  too  little,  they  become  emaciated;  and  of  this  exact  quan- 
tity their  own  palates  judge  the  best. 

M.  M.  In  this  last  case  of  the  diarrhoea  of  children,  the  food 
should  be  new  milk,  which  by  curdling  destroys  part  of  the  acid, 
which  coagulates  it.  Chalk  about  four  grains  every  six  hours, 
with  one  drop  of  spirit  of  hartshorn,  and  half  a drop  of  lauda- 
num. Eut  a blister  about  the  size  of  a shilling  is  of  the  greatest 
service  by  restoring  the  power  of  digestion.  See  Article  III.  2. 
1.  in  the  Materia  Medica. 

6.  Salivatio  calida.  Warm  salivation.  Increased  secretion  of 
saliva.  This  may  be  effected  either  by  stimulating  the  mouth 
of  the  gland  by  mercury  taken  internally;  or  by  stimulating  the 
excretory  duct  of  the  gland  by  pyrethrum,  or  tobacco;  or  sim- 
ply by  the  movement  of  the  muscles,  which  lie  over  the  gland, 
as  in  masticating  any  tasteless  substance,  as  a lock  of  wool,  or 
mastic. 

In  about  the  middle  of  nervous  fevers  a great  spitting  of  saliva 
sometimes  occurs,  which  has  been  thought  critical;  but  as  it  con- 
tinues sometimes  two  or  even  three  weeks  without  the  relief  of 
the  patient,  it  may  be  concluded  to  arise  from  some  accidental 
circumstance,  perhaps  not  unsimilar  to  the  hysteric  ptyalisms 
mentioned  in  Class!.  3.  2.  2.  See  Sect.  XXIV. 


DISEASES 


Class  I.  3.  2.  7. 


22 

M.  M.  Cool  air,  diluents,  warm  bath,  evacuations. 

7.  Catarrhus  ccdidus.  Warm  catarrh.  Consists  in  an  in- 
creased secretion  of  mucus  from  the  nostrils  without  inflamma- 
tion. This  disease,  which  is  called  a cold  in  the  heaa,  is  fre- 
quently produced  by  cold  air  acting  for  some  lime  on  the  mem- 
branes, which  line  the  nostrils,  as  it  passes  to  the  lungs  in  respi- 
ration. Whence  a torpor  of  the  action  of  the  mucous  glands 
is  first  introduced,  as  in  Class  1.  2.  3.  3.  and  an  orgasm  or  in- 
creased action  succeeds  in  consequence.  Afterwards  this  orgasm 
and  torpor  are  liable  to  alternate  with  each  other  tor  some  time 
like  the  cold  and  hot  fits  of  ague,  attended  with  deficient  or  exu- 
berant secretion  of  mucus  in  the  nostrils. 

At  other  times  it  arises  from  reverse  sympathy  with  some  ex- 
tensive parts  of  the  skin,  which  have  been  exposeu  too  iong  to 
cold,  as  of  the  head  or  feet.  In  consequence  of  the  torpoi  of 
these  cutaneous  capillaries  those  of  the  mucous  membranes  of  die 
nostrils  act  with  greater  energy  by  reverse  sympathy ; and  thence 
secrete  more  mucus  from  the  blood.  At  the  same  time  the  ab- 
sorbents, acting  also  with  greater  energy  by  their  reverse  sym- 
pathy with  those  of  some  distant  part  of  the  skin,  absorb  the 
thinner  parts  of  the  mucus  more  hastily;  whence  the  mucus  is 
both  thicker  and  in  greater  quantity.  Other  curious  circumstan- 
ces attend  this  disease;  the  membrane  becomes  at  times  so  thick- 
ened by  its  increased  action  in  secreting  the  mucus,  that  the  pa- 
tient cannot  breathe  through  his  nostrils.  In  this  situation,  if  he 
warms  his  whole  skin  suddenly  by  fire  or  bed-clothes,  or  by 
drinking  warm  tea,  the  increased  action  of  the  membrane  ceases 
by  its  reverse  sympathy  with  the  skin;  or  by  the  retraction  of  the 
sensorial  power  to  other  parts  of  the  system;  and  the  patient  can 
breathe  again  through  the  nostrils.  The  same  sometimes  occurs 
for  a time  on  going  into  the  cold  air  by  the  deduction  of  heat  from 
the  mucous  membrane,  and  its  consequent  inactivity  or  torpor. 
Similar  to  this  when  the  face  and  breast  have  been  very  hot  and 
red,  previous  to  the  eruption  of  the  small-pox  by  inoculation,  and 
that  even  when  exposed  to  cool  air,  I have  observed  the  feet  have 
been  cold;  till  on  covering  them  with  warm  flannel,  as  the  feet 
have  become  w'arm,  the  face  has  cooled.  See  XXXV.  1.  3. 
Class  II.  1.  3.  5.  IV.2.  2.  10.  IV.  1.  1.  5. 

M.  M.  Evacuations,  abstinence,  oil  externally  on  the  nose, 
warm  diluent  fluids,  warm  shoes,  warm  night-cap. 

8.  Expectoratio  calidu.  Warm  expectoration  consists  of  the 
increased  secretion  of  mucus  from  the  membrane,  which  lines 
the  bronchia?,  or  air-cells  of  the  lungs,  without  inflammation. 
This  increased  mucus  is  ejected  by  the  action  of  coughing,  and 


OF  IRRITATION. 


Ciass  1. 1.  2.  9. 


23 


is  called  a cold,  and  resembles  the  catarrh  of  the  preceding  arti- 
cle; with  which  it  is  frequently  combined. 

M.  M.  Inhaling  the  steam  of  warm  water,  evacuations,  warm 
bath,  afterwards  opium,  sorbentia. 

9.  Exsudatio  pone  aures.  A discharge  behind  the  ears.  This 
chiefly  affects  children,  and  is  a morbid  secretion;  as  appears 
from  its  fetor;  for  if  it  was  owing  to  defect  of  absorption,  it 
would  be  saline,  and  not  fetid;  if  a morbid  action  has  continued 
a considerable  time,  it  should  not  be  stopped  too  suddenly;  since 
in  that  case  some  other  morbid  action  is  liable  to  succeed  in  its 
stead.  Thus  children  are  believed  to  have  had  colics,  or  even 
convulsions,  consequent  to  the  too  sudden  healing  of  these  mor- 
bid effusions  behind  their  ears.  The  rationale  of  this  is  to  be  ex- 
plained from  a medical  fact,  which  I have  frequently  observed; 
and  that  is,  that  a blister  on  the  back  greatly  strengthens  the 
power  of  digestion,  and  removes  the  heart-burn  in  adults,  and 
green  stools  in  children.  The  stimulus  of  the  blister  produces 
sensation  in  the  vessels  of  the  skin;  with  this  additional  sensorial 
power  these  vessels  act  more  strongly;  and  with  these  the  ves- 
sels of  the  internal  membranes  of  the  stomach  and  bowels  act 
with  greater  energy  from  their  direct  sympathy  with  them. 
Now  the  acrid  discharge  behind  the  ears  of  children  produces 
sensation  on  that  part  of  the  skin,  and  so  far  acts  as  a small  blis- 
ter. When  this  is  suddenly  stopped,  a debility  of  the  digestive 
power  of  the  stomach  succeeds  from  the  want  of  this  accustomed 
stimulus,  with  flatulency,  green  stools,  gripes,  and  sometimes 
consequent  convulsions.  See  Class  II.  1.  5.  6.  and  II.  1.  4.  6. 

M.  M.  If  the  matter  be  absorbed,  and  produce  swelling  of  the 
lymphatics  of  the  neck,  it  should  be  cured  as  soon  as  possible  by 
dusting  the  part  with  white  lead,  cerussa,  in  very  fine  powder; 
and  to  prevent  any  ill  consequence  an  issue  should  be  kept  for 
about  a month  in  the  arm;  or  a purgative  medicine  should  be 
taken  every  other  day  for  three  or  four  times,  which  should  con- 
sist of  a grain  of  calomel,  and  three  or  four  grains  of  rhubarb, 
and  as  much  chalk.  If  there  be  no  appearance  of  absorption, 
it  is  better  only  to  keep  the  parts  clean  by  washing  them  with 
warm  water,  morning  and  evening;  or  putting  fuller’s  earth  on 
them;  especially  till  the  time  of  toothing  is  past.  The  tinea,  or 
scald  head,  and  a leprous  eruption,  which  often  appears  behind 
the  ears,  are  different  diseases. 

10.  Gonorrhoea  calida.  Warm  gleet.  Increased  discharge  of 
mucus  from  the  urethra  or  prostate  gland  without  venereal  de- 
sire, or  venereal  infection.  See  Class  I.  2.  3.  8. 

M.  M.  Cantharides,  balsams,  rhubarb,  blister  on  perinaeum, 


21 


DISEASES 


Class  I.  1.  2.  11. 


cold  bath,  injections  of  metallic  salts,  flannel  shirt,  change  of  the 
form  of  the  accustomed  chair  or  saddle  of  the  patient. 

11.  Fluor  albus  calides.  Warm  fluor  albus.  Increased  secre- 
tion of  mucus  in  the  vagina  or  uterus  without  venereal  desire  or 
venereal  infection.  It  is  distinguished  from  the  fluor  albus  frigi- 
dus  by  the  increased  sense  of  ivarmth  in  the  part,  and  by  the 
greater  opacity  or  spissitude  of  the  material  discharged;  as  the 
thinner  parts  are  re-absorbed  by  the  increased  action  of  the  ab- 
sorbents, along  with  the  saline  part,  whence  no  smarting  or  ex- 
coriation attends  it. 

M.  M.  Mucilage,  as  isinglass,  hartshorn  jelly,  gum  arabic. 
Ten  grains  of  rhubarb  every  night.  Calico  or  flannel  shift, 
opium,  balsams.  See  Class  I.  2.  3.  7. 

12.  Jlcemorrhois  alba.  White  piles.  An  increased  discharge 
of  mucus  from  the  rectum  frequently  mistaken  for  matter;  is  said 
to  continue  a few  weeks,  and  recur  like  the  bleeding  piles;  and 
to  obey  lunar  influence.  See  Class  1.  2.  1.  6. 

M.  M.  Abstinence  from  vinous  spirit.  Balsam  of  copaiva. 
Spice  swallowed  in  large  fragments,  as  ten  or  fifteen  black  pep- 
per-corns cut  in  half,  and  taken  after  dinner  and  supper.  Ward’s 
paste,  consisting  of  black  pepper  and  the  powdered  root  of  He- 
lenium  Enula. 

13.  Serum  e vesicatorio.  Discharge  from  a blister.  The  ex- 
cretory ducts  of  glands  terminate  in  membranes,  and  are  endu- 
ed with  great  irritability,  and  many  of  them  with  sensibility;  the 
latter  perhaps  in  consequence  of  their  facility  of  being  excitable 
into  great  action;  instances  of  this  are  the  terminations  of  the 
gall-duct  in  the  duodenum,  and  of  the  salivary  and  lachrymal 
glands  in  the  mouth  and  eye;  which  produce  a greater  secre- 
tion of  their  adapted  fluids,  when  the  ends  of  their  excretory 
ducts  are  stimulated. 

The  external  skin  consists  of  the  excretory  ducts  of  the  capil- 
laries, with  the  mouths  of  the  absorbents;  when  these  are  stimu- 
lated by  the  application  of  cantharides,  or  by  a slice  of  the  fresh 
root  of  bryonia  alba  bound  on  it,  the  capillary  glands  pour  an  in- 
creased quantity  of  fluid  upon  the  skin  by  their  increased  action; 
and  the  absorbent  vessels  imbibe  a greater  quantity  of  the  more 
fluid  and  saline  part  of  it;  whence  a thick  mucous  or  serous  fluid 
is  deposited  between  the  skin  and  cuticle. 

14.  Perspiralioj otlida.  Fetid  perspiration.  The  uses  of  the 
perspirable  matter  are  to  keep  the  skin  soft  and  pliant,  for  the 
purposes  of  its  easier  flexibility  during  the  activity  of  our  limbs  in 
locomotion,  and  for  the  preservation  of  the  accuracy  of  the  sense 
of  touch,  which  is  diffused  under  the  whole  surface  of  it  to 
guard  us  against  the  injuries  of  external  bodies;  in  the  same 


Cuss  I.  1.  2. 14. 


OF  IRRITATION. 


25 


manner  as  the  secretion  of  tears  is  designed  to  preserve  the  cor- 
nea of  the  eye  moist,  and  in  consequence  transparent;  yet  has 
this  cutaneous  mucus  been  believed  by  many  to  be  an  excrement; 
and  I know  not  how  many  fanciful  theories  have  been  built  on  its 
supposed  obstruction.  Such  as  the  origin  of  catarrhs,  coughs, 
inflammations,  erysipelas,  and  herpes. 

To  all  these  it  may  be  sufficient  to  answer,  that  the  ancient 
Grecians  oiled  themselves  all  over;  that  some  nations  have 
painted  themselves  all  over,  as  the  Piets  of  this  island;  that  the 
Hottentots  smear  themselves  all  over  with  grease.  And  lastly, 
that  many  of  our  own  heads  at  this  day  are  covered  with  the 
flour  of  wheat  and  the  fat  of  hogs,  according  to  the  tyranny  of  a 
filthy  and  wasteful  fashion,  and  all  this  without  inconvenience. 
To  this  must  be  added  the  strict  analogy  between  the  use  of  the 
perspirable  matter  and  the  mucous  fluids,  which  are  poured  for 
similar  purposes  upon  all  the  internal  membranes  of  the  body; 
and  besides  its  being  in  its  natural  state  inodorous;  which  is  not 
so  with  the  other  excretions  of  feces,  or  of  urine. 

The  quantity  of  perspirable  matter  being  greater  than  that  of 
the  excrementitious  matters  voided  by  stool  and  urine,  has  been 
used  as  an  argument  in  favour  of  its  being  an  excrement;. the  force 
of.  which  I do  not  see:  but  can  readily  understand,  that  there 
must  of  necessity  be  a great  exhalation  of  a fluid  which  is  diffused 
over  the  whole  external  surface  of  the  warm  skin,  and  perhaps 
warmer  lungs,  for  the  purpose  of  keeping  them  moist  and  pliant, 
and  which  is  perpetually  renewed  as  it  evaporates;  but,  if  it  be 
conceived  to  be  an  excrement,  there  seems  to  have  been  no  ne- 
cessity for  its  quantity  being  so  great. 

The  evaporation  of  this  great  quantity  of  fluid  secreted  on  the 
surface  of  the  skin  and  lungs,  must  carry  off  much  heat  from  the 
body;  and  as  both  this  secretion  and  consequent  evaporation  will 
be  in  proportion  to  the  activity  of  the  cutaneous  vessels,  and  the 
heat  occasioned  by  their  increased  secretion,  it  would  seem,  that 
this  evaporation  of  perspirable  matter  is  the  cause  which  preserves 
the  animal  body  at  the  uniform  degree  of  heat  of  98;  in  the 
same  manner  as  the  evaporation  of  boiling  water  preserves  it  at 
212  degrees  of  Fahrenheit’s  scale. 

The  peculiar  use  of  the  perspirable  matter  in  preserving  the 
membranes  moist,  which  Hue  the  air  pipes  of  the  lungs,  appears 
from  the  curious  discovery  of  Dr.  Priestley,  that  the  oxygen  of  the 
atmosphere  will  pass  through  moist  animal  membranes,  but  not 
through  dry  ones,  so  that  if  the  membranes  of  the  trachea  were  to 
become  dry,  the  animal  must  as  immediately  perish  as  if  he  was 
to  breath  azotic  gas  alone.  See  Sect.  XXVIII.  2.  of  the  pre- 
ceding volume. 

VOL.  II. 


E 


26 


DISEASES 


Class  I.  1.  2.  14 


In  some  constitutions  the  perspirable  matter  of  the  lungs  ac- 
quires a disagreeable  odour;  in  others  the  axilla,  and  in  others 
the  feet,  emit  disgustful  effluvia;  like  the  secretions  of  those 
glands  which  have  been  called  odoriferas;  as  those,  which  con- 
tain the  castor  in  the  beaver,  and  those  within  the  rectum  of 
dogs,  the  mucus  of  which  has  been  supposed  to  guard  them 
against  the  great  costiveness,  which  they  are  liable  to  in  hot 
summers;  and  which  has  been  thought  to  occasion  canine  mad- 
ness, but  which,  like  their  white  excrement,  is  more  probably 
owing  to  the  deficient  secretion  of  bile.  Whether  these  odorife- 
rous particles  attend  the  perspirable  matter  in  consequence  of 
the  increased  action  of  the  capillary  glands,  and  properly  be 
called  excrementitious;  that  is,  whether  any  thing  is  eliminated, 
which  could  be  hurtful  if  retained;  or  whether  they  may  only 
contain  some  of  the  essential  oil  of  the  animal;  like  the  smell, 
which  adheres  to  one’s  hand  on  stroking  the  hides  of  some 
dogs;  or  like  the  effluvia,  which  is  left  upon  the  ground,  from 
the  feet  of  men  and  other  creatures,  and  is  perceptible  by 
the  nicer  organs  of  the  dogs,  which  hunt  them,  may  admit  of 
doubt. 

Add  to  this,  that  some  parts  of  the  skin  are  liable  to  more 
profuse  perspiration  than  other  parts  without  possessing  any  fetid 
scent,  as  the  skin  of  the  face,  on  any  more  violent  exercise.  This 
seems  to  have  been  observed  very  early  in  the  history  of  man- 
kind, as  it  was  said,  that  our  first  parents  should  earn  their  bread 
by  the  sweat  of  their  brow.  Why  this  circumstance  does  not 
attend  other  animals  is  a curious  inquiry.  Mankind  soon  learned 
to  cover  their  bodies,  except  their  faces,  with  clothes;  when  the 
face,  by  being  more  frequently  exposed  to  greater  variations  of 
heat  and  cold,  acquired  greater  irritability,  or  sensibility,  or 
associability,  and  thus  has  become  more  excitable  into  greater 
action  by  the  stimulus  of  exercise,  or  by  that  of  food,  or  by  the 
Variolous  infection,  than  other  parts  of  the  skin,  as  spoken  of  in 
Class  IY.  1.  2.  12;  which  also  appears  by  its  sympathy  with 
diseases  of  the  liver  or  stomach  by  sensitive  associations,  as  in  the 
gutta  rosea.  From  all  these  analogous  facts  the  profuse  sweat, 
which  exudes  from  the  face  on  exercise,  does  not  appear  to  be 
an  excrementitious  fluid,  but  simply  the  consequence  of  more 
violent  action  of  the  cutaneous  or  perspirative  glands. 

M.  M.  Wash  the  part  twice  a day  with  soap  and  water; 
with  lime  water;  cover  the  feet  with  oiled  silk  socks,  which 
must  be  washed  night  and  morning.  Cover  them  with  charcoal 
recently  made  red  hot,  and  beaten  into  fine  powder  and  sifted, 
as  soon  as  cold,  and  kept  well  corked  in  a bottle,  to  be  washed 


Cuss  I.  1.  2.  15. 


OF  IRRITATION. 


27 


off  and  renewed  twice  a day.  Internally  rhubarb  grains  vi.  or 
viii.  every  night,  so  as  to  procure  a stool  or  two  extraordinary 
every  day,  and  thus  by  increasing  one  evacuation  to  decrease 
another.  Cool  dress,  diluting  liquids? 

15.  Crinesnovi.  New  hairs.  The  black  points  on  the  faces 
of  some  people  consist  of  mucus,  which  is  become  viscid,  and 
which  adheres  in  the  excretory  ducts  of  the  glands  of  the  skin;  as 
described  in  Class  I.  2.  2.  9.  and  which  may  be  pressed  out  by 
the  fingers,  and  resembles  little  worms.  Similar  to  this  would 
seem  the  fabrication  of  silk  and  of  cobweb,  by  the  silk-worm 
and  spider;  which  is  a secreted  matter  pressed  through  boles, 
which  are  the  excretory  ducts  of  glands.  And  it  is  probable, 
that  the  production  of  hair  on  many  parts  of  the  body,  and  at 
different  periods  of  life,  may  be  effected  by  a similar  process;  and 
more  especially  as  every  hair  may  be  considered  as  a slender 
flexible  horn,  and  is  an  appendage  of  the  skin.  See  Sect. 
XXXIX.  3.  2.  Now  as  there  is  a sensitive  sympathy  between 
the  glands,  which  secrete  the  semen,  and  the  throat,  as  appears 
in  the  mumps;  see  Hydrophobia,  Class  IV.  1.  2.  7.  and  Paro- 
titis, Class  IV.  1.  2.  19.  the  growth  of  the  beard  at  puberty 
seems  to  be  caused  by  the  greater  action  of  the  cutaneous  glands 
about  the  chin  and  pubes  in  consequence  of  their  sympathy  with 
those  of  the  testes.  But  this  does  not  occur  to  the  female  sex  at 
their  time  of  puberty,  because  the  sensitive  sympathy  in  them 
seems  to  exist  between  the  submaxillary  glands,  and  the  pectoral 
ones;  which  secrete  the  milk,  and  afford  pleasure  both  by  that 
secretion,  and  by  the  erection  of  the  mammulae,  or  nipples;  and 
by  delivering  the  milk  into  the  mouth  of  the  child;  this  sen- 
sitive sympathy  of  the  pectoral  and  submaxillary  glands  in  wo- 
men is  also  observable  in  the  Parotitis,  or  mumps,  as  above  re- 
ferred to. 

When  hairs  grow  on  the  face  or  arms  so  as  to  be  disagree- 
able, they  may  be  thus  readily  removed  without  pain  or  any  ill 
consequence.  Warm  the  ends  of  a pair  of  nippers  or  forceps, 
and  stick  on  them  a little  resin,  or  Burgundy  pitch;  by 
these  means  each  single  hair  may  be  taken  fast  hold  of;  and 
if  it  be  then  plucked  off  slowly,  it  gives  pain;  but  if  plucked 
off  suddenly,  it  gives  no  pain  at  all;  because  the  vis  inertim 
of  the  part  of  the  skin,  to  which  it  adheres,  is  not  overcome; 
and  it  is  not  in  consequence  separated  from  the  cellular  mem- 
brane under  it.  Some  of  the  hairs  may  return,  which  are 
thus  plucked  off,  or  others  may  be  induced  to  grow  near  them; 
but  in  a little  time  they  may  be  thus  safely  destroyed;  which 
is  much  to  be  preferred  to  the  methods  said  to  be  used  in  Turkey 


28 


DISEASES 


Class  I.  1.  2.  IS. 


to  eradicate  hair;  such  as  a mixture  of  orpiment  and  quick  lime; 
or  of  liver  of  sulphur  in  solution;  which  injure  the  skin,  if  they 
are  not  very  nicely  managed;  and  the  hair  is  liable  to  grow  again 
as  after  shaving;  or  to  become  white,  if  the  roots  of  it  have  been 
much  inflamed  by  the  causticity  of  the  application.  See  Class 
1.  2.2.  11.  on  grey  hairs. 


Class  I.  1.  3.1. 


OF  IRRITATION 


29 


ORDO  I. 

Increased  Irritation. 

GENUS  III. 

With  Increased  Actions  of  the  Absorbent  System. 

These  are  not  attended  with  so  great  increase  of  heat  as  in  the 
former  genus,  because  the  fluids  probably  undergo  less  chemical 
change  in  the  glands  of  the  absorbent  system;  nor  are  the  glands 
of  the  absorbent  vessels  so  numerous  or  so  extensive  as  those  of 
the  secerning  ones.  Yet  that  some  heat  is  produced  by  the  in= 
creased  action  of  the  absorbents  appears  from  the  greater  gene- 
ral warmth  of  the  skin  and  extremities  of  feeble  patients  after 
the  exhibition  of  the  Peruvian  bark,  and  other  medicines  of  the 
article  Sorbentia. 

SPECIES. 

1.  Lingua  arida.  Dry  tongue  occurs  in  those  fevers,  where 
the  expired  air  is  warmer  than  natural;  and  happens  to  all  those, 
who  sleep  with  their  mouths  open;  the  currents  of  air  in  respira- 
tion increasing  the  evaporation.  There  is  also  a dryness  in 
the  mouth  from  the  increased  action  of  the  absorbent  vessels, 
the  mouth  from  the  increased  action  of  the  absorbent  vessels, 
when  a sloe  or  a crab-apple  is  masticated;  and  after  the  perspira- 
tion has  been  much  increased  by  eating  salt  or  spice,  or  after 
other  copious  secretions;  as  after  drunkenness,  cathartics  or 
fever  fits,  the  mucus  of  the  mouth  becomes  viscid,  and  in  small 
quantity,  from  the  increased  absorption,  adhering  to  the  tongue 
like  a white  slough.  In  the  diabetes,  where  the  thirst  is  very 
great,  this  slough  adheres  more  pertinaciously,  and  becomes  black 
or  brown,  being  coloured  after  a few  days  by  our  aliment  or 
drink.  The  inspissated  mucus  on  the  tongue  of  those,  who  sleep 
with  their  mouths  open,  is  sometimes  reddened  as  if  mixed  with 
blood,  and  sometimes  a little  blood  follows  the  expuition  of  it 
from  the  fauces  owing  to  its  great  adhesion.  When  this  mucus 
adheres  long  to  the  papillas  of  the  tongue,  the  saliva,  which  it 
contains  in  its  interstices,  like  a sponge,  is  liable  to  become  pu- 
trid, and  to  acquire  a bitter  taste,  like  other  putrid  animal  sub- 
stances; which  is  generally  mistaken  for  an  indication  of  the 
presence  of  bile. 

M.  M.  Warm  subacid  liquids.  See  Class  I.  2.  5.  8. 

2.  Fauces  arida;.  Dry  throat.  The  expuition  of  a frothy 


30 


DISEASES 


Class  1. 1.  3.  3. 


mucus  with  great  and  perpetual  hawking  occurs  in  hydrophobia, 
and  is  very  distressing  to  the  patient;  which  may  be  owing  to 
the  increased  irritability  or  sensibility  of  the  upper  part  of  the 
oesophagus,  which  will  not  permit  any  fluid  to  rest  on  it. 

It  affects  some  people  after  intoxication,  when  the  lungs  re- 
main slightly  inflamed,  and  by  the  greater  heat  of  the  air  in  ex- 
piration the  mucus  becomes  too  hastily  evaporated,  and  is  ex- 
pectorated with  difficulty  in  the  state  of  white  froth. 

I knew  a person,  who  for  twenty  years  always  waked  with  his 
tongue  and  throat  quite  dry;  so  that  he  was  necessitated  to  take 
a spoonful  of  water,  as  soon  as  he  awoke;  otherwise  a little  blood 
always  followed  the  forcible  expuilion  of  the  indurated  mucus 
from  his  fauces.  See  Class  11.  1.  3.  17. 

M.  M.  Steel-springs  fixed  to  the  night-cap  so  as  to  suspend  the 
lower  jaw  and  keep  it  closed;  or  springs  of  elastic  gum.  Or  a 
pot  of  water  suspended  over  the  bed,  with  a piece  of  list,  or 
woollen  cloth,  depending  from  it,  and  held  in  the  mouth;  which 
will  act  like  a syphon,  and  slowly  supply  moisture,  or  barley  wa- 
ter should  be  frequently  syringed  into  the  mouth  of  the  patient. 

3.  Nares  aridi.  Dry  nostrils  with  the  mucus  hardening  upon 
their  internal  surface,  so  as  to  cover  them  with  a kind  of 
skin  or  scale,  owing  to  the  increased  action  of  the  absorbents  of 
this  membrane;  or  to  the  too  great  dryness  of  the  air,  which 
passes  into  the  lungs;  or  >oo  great  heat  of  it  in  its  expiration. 

When  air  is  so  dry  as  to  lose  its  transparency;  as  w’hen  a tremu- 
lous motion  of  it  can  be  seen  over  corn-fields  in  a hot  summer’s 
day;  or  w'hen  a dry  mist,  or  want  of  transparency  of  the  air,  is 
visible  in  very  hot  weather;  the  sense  of  smell  is  at  the  same 
time  imperfect  from  the  dryness  of  the  membrane,  beneath 
which  it  is  spread. 

4.  Expectoralio  solida.  Solid  expectoration.  The  mucus  of 
the  lungs  becomes  hardened  by  the  increased  absorption,  so 
that  it  adheres  and  forms  a kind  of  lining  in  the  air  cells,  and  is 
sometimes  spit  up  in  the  form  of  branching  vessels,  which  are 
called  polypi  of  the  lungs.  See  Transact,  of  the  College,  Lon- 
don. There  is  a rattling  or  wheezing  of  the  breath,  but  it  is 
not  at  first  attended  with  inflammation. 

The  Cynanche  trachealis,  or  Croup,  of  Dr.  Cullen,  or  Angina 
polyposa  of  Michaeiis,  if  they  differ  from  the  peripneumony  of 
infants,  seem  to  belong  to  this  genus.  "When  the  difficulty  of  res- 
piration is  great,  venesection  is  immediately  necessary,  and  then 
an  emetic  and  a blister.  And  the  child  should  be  kept  nearly 
upright  in  bed  as  much  as  maybe.  See  Tonsillitis,  Class  II.  1, 
3.  3.  and  II.  1.2.  4. 

M.  M.  Diluents,  emetics,  essence  of  antimony,  foetid  gums, 


Class  1. 1.  3.  5. 


OF  IRRITATION. 


31 


onions,  warm  bath  for  half  an  hour  every  day  for  a month.  In- 
haling the  steam  of  water,  with  or  without  volatile  alkali.  Soap. 

5.  Constipatio  alvi.  Costiveness  from  increased  action  of  the 
intestinal  absorbents.  The  feces  are  hardened  in  lumps  called 
scybala;  which  are  sometimes  obliged  to  be  extracted  from  the 
rectum  with  a kind  of  marrow  spoon.  This  is  said  to  have  hap- 
pened from  the  patient  having  taken  much  rust  of  iron.  The 
mucus  is  also  hardened  so  as  to  line  the  intestines,  and  to  come 
away  in  skins,  rolled  up  as  they  pass  along,  so  as  to  resemble 
worms,  for  which  they  are  frequently  mistaken;  and  sometimes 
it  is  evacuated  in  still  larger  pieces,  so  as  to  counterfeit  the  form 
of  the  intestines,  and  has  been  mistaken  for  a portion  of  them. 
Balls  of  this  kind,  nearly  as  heavy  as  marble,  and  considerably 
hard,  from  two  inches  to  five  in  diameter,  are  frequently  found  in 
the  bowels  of  horses.  Similar  balls  found  in  goats  have  been 
called  Bezoar. 

M.  M.  Cathartics.  Diluents,  fruit,  oil,  soap,  sulphur,  warm 
bath.  Sprinkling  with  cold  water,  cool  clothing.  See  Class  I. 
2.  4.  18. 

6.  Cutis  arida.  Dry  skin.  This  dry  skin  is  not  attended  with 
coldness  as  in  the  beginning  of  fever- fits.  Where  this  cutaneous 
absorption  is  great,  and  the  secreted  material  upon  it  viscid,  as 
on  the  hairy  scalp,  the  skin  becomes  covered  with  hardened  mu- 
cus; which  adheres  so  as  not  to  be  easily  removed,  as  the  scurf 
on  the  head;  but  is  not  attended  with  inflammation  like  the 
Tinea,  or  Lepra.  The  moisture,  which  appears  on  the  skin  be- 
neath resinous  or  oily  plasters,  or  which  is  seen  to  adhere  to  such 
plasters,  is  owing  to  their  preventing  the  exhalation  of  the  per- 
spirable matter,  and  not  to  their  increasing  the  production  of  it, 
as  some  have  idly  imaginned. 

M.  M.  Warm  bathing,  oil  externally,  oil-skin  gloves,  resinous 
plasters.  Wax. 

7.  Urina parca  colorata.  Diminished  urine,  which  is  high  co- 
loured, and  deposits  an  earthy  sediment,  when  cold,  is  owing  to 
the  great  action  of  the  urinary  absorbents.^  See  Class  I.  1.  2. 
4.  In  some  dropsies  the  cutaneous  absorbents  are  paralytic,  as 
well  as  those  opening  into  the  cellular  membrane;  and  hence 
no  moisture  being  acquired  from  the  atmosphere,  or  from  the 
cellular  membrane,  great  thirst  is  excited;  and  great  absorption 
from  all  parts,  where  the  absorbents  are  still  capable  of  action. 
Hence  the  urine  is  in  very  small  quantity,  and  of  deep  colour, 
with  copious  sediment;  and  the  kidneys  are  erroneously  blamed 
for  not  doing  their  office;  stimulant  diuretic  medicines  are  given 
in  vain;  and  very  frequently  the  unhappy  patient  is  restrain- 
ed from  quenching  his  thirst,  and  dies  a martyr  to  false  theory. 


32 


DISEASES 


Class  I.  1.  3.  8. 


M.  M.  Diluent  liquids,  and  warm  bathing,  are  the  natural 
cure  of  this  symptom;  but  it  generally  attends  those  dropsies, 
which  are  seldom  curable;  as  they  are  owing  to  a paralysis  both 
of  the  cutaneous  and  cellular  lymphatics. 

8.  Calculus felleus.  Gall-stone.  From  the  too  hasty  absorp- 
tion of  the  thinner  parts  of  the  bile,  the  remainder  is  left  too 
viscid,  and  crystallizes  into  lumps;  which  if  too  large  to  pass, 
obstruct  the  ductus  cboledochus,  producing  pain  at  the  pit  of 
the  stomach,  and  jaundice.  When  the  indurated  bile  is  not 
harder  than  a boiled  pea,  it  may  pass  through  'he  bile  duct  with 
•difficulty  by  changing  its  form;  and  thus  gives  those  pains, 
which  have  been  called  spasms  of  the  stomach;  and  yet  these 
viscid  lumps  of  bile  may  afterwards  dissolve,  and  not  be  visible 
among  the  feces. 

In  two  instances  I have  seen  from  thirty  to  fifty  gall-stones 
voided  after  taking  an  oil  vomit  as  below.  They  were  about 
the  size  of  peas,  and  distinguishable  when  dry  by  their  being  in- 
flammable like  bad  wax,  when  put  into  the  flame  of  a candle. 
For  other  causes  of  jaundice,  See  Class  I.  2.  4.  19. 

M.  M.  Diluents,  daily  warm  bathing.  Ether  mixed  with 
yolk  of  egg  and  water.  Unboiled  acrid  vegetables,  as  lettuce, 
cabbage,  mustard,  and  cresses.  When  in  violent  pain,  four 
ounces  of  oil  of  olives,  or  of  almonds,  should  be  swallowed;  and 
as  much  more  in  a quarter  of  an  hour,  whether  it  stays  or  not. 
The  patient  should  lie  on  the  circumference  of  a large  barrel, 
first  on  one  side,  and  then  on  the  other.  Electric  shocks  through 
the  gall-duct.  Factitious  Seltzer  water  made  by  dissolving  one 
dram  of  sal  soda  in  a pint  of  water;  to  half  a pint  of  which  made 
luke-warm  add  ten  drops  of  marine  acid;  to  be  drunk  as  soon  as 
mixed,  twice  a day  for  some  months.  Opium  must  be  used  to 
quiet  the  pain,  if  the  oil  does  not  succeed,  as  two  grains,  aud 
another  grain  in  half  an  hour  if  necessary.  See  Ciass  H . 2.  2.  4. 

9.  Calculus  renis.  Stone  of  the  kidney.  The  pain  in  the  loins 
and  along  the  course  of  the  ureter  from  a stone  is  attended  with 
retraction  of  the  testicle  in  men,  and  numbness  on  the  inside  of 
the  thigh  in  women.'  It  is  distinguished  from  the  lumbago  or 
sciatica,  as  these  latter  are  seldom  attended  with  vomiting,  and 
have  pain  on  the  outside  of  the  thigh,  sometimes  quite  down  to 
the  ancle  or  heel.  See  Herpes  and  Nephritis. 

Where  the  absorption  of  the  thinner  parts  of  the  secretion 
takes  place  too  hastily  in  the  kidneys,  the  hardened  mucus,  and 
consequent  calculus  concretions,  sometimes  totally  stop  up  the 
tubuli  uriniferi,  and  no  urine  is  secreted.  Of  this  many  die, 
who  have  drunk  much  vinous  spirit,  and  some  of  them  recover 
by  voiding  a quantity  of  white  mucus,  like  chalk  and  water;  and 


Class  I.  1.  3.  9. 


OF  IRRITATION. 


others  by  voiding  a great  quantity  of  sand  or  small  calculi.  This 
hardened  mucus  frequently  becomes  the  nucleus  of  a stone  in  the 
bladder.  The  salts  of  the  urine,  called  microcosmic  salt,  are  of- 
ten mistaken  for  gravel,  but  are  distinguishable  both  by  their  an- 
gles of  crystallization,  their  adhesion  to  the  sides  or  bottom  of 
the  pot,  and  by  their  not  being  formed  till  the  urine  cools. 
Whereas  the  particles  of  gravel  are  generally  without  angles,  and 
always  drop  to  the  bottom  of  the  vessel,  immediately  as  the  wa- 
ter is  voided. 

Though  the  proximate  cause  of  the  formation  of  the  calculous 
concretions  of  the  kidneys,  and  of  chalk  stones  in  the  gout,  and 
of  the  insoluble  concretions  of  coagulable  lymph,  which  are  found 
on  membranes,  which  have  been  inflamed  in  peripneumony,  or 
rheumatism,  consists  in  the  too  great  action  of  the  absorbent 
vessels  of  those  parts;  yet  the  remote  causes  of  these  cases  is 
probably  owing  to  the  inflammation  of  the  membranes;  which 
at  that  time  are  believed  to  secrete  a material  more  liable  to  co- 
agulate or  concrete,  than  they  would  otherwise  produce  by  in- 
creased action  alone  without  the  production  of  new  vessels,  which 
constitutes  inflammation.  As  defined  in  Class  II.  1.  2. 

The  fluids  secreted  from  the  mucous  membranes  of  animals 
are  of  various  kinds  and  consistencies.  Hair,  silk,  scales,  horns, 
finger-nails,  are  owing  to  natural  processes.  Gall-stones,  stones 
found  in  the  intestines  of  horses,  scurf  of  the  skin  in  leprosy, 
stones  of  the  kidneys  and  bladder,  the  callus  from  the  inflamed 
periosteum,  which  unites  broken  bones,  the  calcareous  cement, 
which  repairs  the  injured  shells  of  snails,  the  calcareous  crust  on 
the  eggs  of  birds,  the  annually  renewed  shells  of  crabs,  are  all 
instances  of  productions  from  mucous  membranes,  afterwards  in- 
durated by  absorption  of  their  thinner  parts. 

All  these  concretions  contain  phosphoric  acid,  mucus,  and 
calcareous  earth  in  different  proportions;  and  are  probably  so 
far  analogous  in  respect,  to  their  component  parts  as  well  as  their 
mode  of  formation.  Some  calcareous  earth  has  been  discovered 
after  putrefaction  in  the  coagulable  lymph  of  animals.  Fordyce’s 
Elements  of  Practice.  A little  calcareous  earth  was  detected  by 
Scheele  or  Bergman  in  the  calculus  of  the  bladder  with  much 
phosphoric  acid,  and  a great,  quantity  of  phosphoric  acid  is  shewn 
to  exist  in  oyster-shells  by  their  becoming  luminous  on  exposing 
them  a while  to  the  sun’s  light  after  calcination;  as  in  the  expe- 
riments of  Wilson.  Botanic  Garden,  P.  1.  Canto  1.  1.  182,  note. 
The  exchange  of  which  phosphoric  acid  for  carbonic  acid  or 
fixed  air,  converts  shells  into  lime-stone,  producing  mountains  of 
marble,  or  calcareous  strata. 

Now  as  the  hard  lumps  of  calcareous  matter,  termed  crabs’ 

VOL  II.  f 


34 


DISEASES 


Class  I.  1.  3.  9- 


eyes,  which  are  found  in  the  stomachs  of  those  animals  previous 
to  the  annual  renewal  of  their  shells,  are  redissolved,  probably 
by  their  gastric  acid,  and  again  deposited  for  that  purpose;  may 
it  not  be  concluded,  that  the  stone  of  the  bladder  might  be  dis- 
solved by  the  gastric  juice  of  fish  of  prey,  as  of  crabs  or  pike;  or 
of  voracious  young  birds,  as  young  rooks  or  hawks,  or  even  of 
calves?  Could  not  these  experiments  be  tried  by  collecting  the 
gastric  juice  by  putting  bits  of  sponge  down  the  throats  of  voung 
crows,  and  retracting  them  by  a string  in  the  manner  of  Spal- 
lanzani? or  putting  pieces  of  calculus  down  the  throat  of  a liv- 
ing crow,  or  pike,  and  observing  if  they  become  digested?  and 
lastly,  could  not  gastric  juice,  if  it  should  appear  to  be  a solvent, 
be  injected  and  borne  in  the  bladder  without  injury  by  means  of 
catheters  of  elastic  resin,  or  caoutchouc? 

M.  M.  Diluents.  Cool  dress.  Frequent  change  of  posture. 
Frequent  horizontal  rest  in  the  day.  Bathe  the  loins  every  morn- 
ing with  a sponge  and  cold  water.  Aerated  alkaline  water  in- 
ternally. Abstinence  from  all  fermented  or  spirituous  liquors. 
Whatever  increases  perspiration  injures  these  patients,  as  it  dis- 
sipates the  aqueous  particles,  which  ought  to  dilute  the  urine. 
When  the  constitution  begins  to  produce  gravel,  it  may  I believe 
be  certainly  prevented  by  a total  abstinence  from  fermented  or 
spirituous  liquors;  by  drinking  much  aqueous  fluids;  as  toast 
and  water,  tea,  milk  and  wTater,  lemonade;  and  lastly,  by  thin 
clothing,  and  sleeping  on  ahardish  bed,  that  the  patient  may  not 
lie  too  long  on  one  side.  See  Class  IV.  2.  2.  2.  There  is  rea- 
son to  believe,  that  the  daily  use  of  opium  contributes  to  produce 
gravel  in  the  kidneys  by  increasing  absorption,  when  they  are 
inflamed;  in  the  same  manner  as  is  done  by  fermented  or  spirit- 
uous liquor.  See  Class  1.3.2.  11. 

When  the  kidneys  are  so  obstructed  with  gravel,  that  no  urine 
passes  into  the  bladder;  which  is  known  by  the  external  appear- 
ance of  the  lower  part  of  the  abdomen,  which,  when  the  bladder 
is  full,  seems  as  if  contracted  by  a cord  between  the  navel  and 
the  bladder;  and  by  the  tension  on  the  region  of  the  bladder 
distinguishable  by  the  touch;  or  by  the  introduction  of  the  ca- 
theter; the  following  methods  of  cure  are  frequently  successful. 
Venesection  to  six  or  eight  ounces,  ten  grains  of  calomel,  and 
an  infusion  of  senna  with  salts  and  oil,  every  three  hours,  till 
stools  are  procured.  Then  an  emetic.  After  the  patient  has 
been  thus  evacuated,  a blister  on  the  loins  should  be  used;  and 
from  ten  to  twenty  electric  shocks  should  be  passed  through  the 
kidneys,  as  large  as  can  be  easily  borne,  once  or  twice  a day. 
Along  with  this  method  the  warm  bath  should  be  used  for  an 
hour  once  or  twice  a day.  After  repeated  evacuations,  a clyster, 


Cxass  I.  1.  3.  10. 


OF  IRRITATION. 


So 


consisting  of  two  drams  of  turpentine  dissolved  by  yolk  of  egg, 
and  sixty  drops  of  tincture  of  opium,  should  be  used  at  night, 
and  repeated,  with  cathartic  medicines  interposed,  every  night, 
or  alternate  nights.  Aerated  solution  of  alkali  should  be  taken 
internally,  and  balsam  of  copaiva,  three  or  four  times  a day. 
Some  of  these  patients  recover  after  having  made  no  water  for 
nine  or  ten  days. 

If  a stone  sticks  in  the  ureter  with  incessant  vomiting  ten  grains 
of  calomel  must  be  given  in  small  pills  as  above;  and  some  hours 
afterwards  infusion  of  senna  and  salts  and  oil,  if  it  can  be  made 
to  stay  on  the  stomach.  And  after  the  purge  has  operated  four 
or  five  times,  an  opiate  is  to  be  given,  if  the  pain  continues,  con- 
sisting of  two  grains  of  opium.  If  this  does  not  succeed,  ten  or 
twenty  electric  shocks  through  the  kidney  should  be  tried,  and 
the  purgative  repeated,  and  afterwards  the  opiate.  The  patient 
should  be  frequently  put  into  the  warm  bath  for  an  hour  at  a 
time.  Eighty  or  a hundred  drops  of  laudanum  given  in  a clys- 
ter, with  two  drams  of  turpentine,  are  to  be  preferred  to  the  two 
grains  given  by  the  stomach  as  above,  when  the  pain  and  vomit- 
ing are  very  urgent. 

10.  Calculus  Vesica.  Stone  of  the  bladder.  The  nucleus,  or 
kernel,  of  these  concretions  is  always  formed  in  the  kidney,  as 
above  described;  and  passing  down  the  ureter  into  the  bladder, 
is  there  perpetually  increased  by  the  mucus  and  salts  secreted 
from  the  arterial  system,  or  by  the  mucus  of  the  bladder,  dispos- 
ed in  concentric  strata.  The  stones  found  in  the  bowels  of 
horses  are  also  formed  on  a nucleus,  and  consist  of  concentric 
spheres;  as  appears  in  sawing  them  through  the  middle.  But 
as  these  are  formed  by  the  indurated  mucus  of  the  intestines  alone 
without  the  urinary  salts,  it  is  probable  a difference  would  be 
found  on  their  analysis. 

As  the  stones  of  the  bladder  are  of  various  degrees  of  hardness, 
and  probably  differ  from  each  other  in  the  proportions  at  least  of 
their  component  parts;  when  a patient,  who  labours  under  this 
afflicting  disease,  voids  any  small  bits  of  gravel;  these  should  be 
kept  in  warm  solutions  of  caustic  alkali,  or  of  mild  alkali  well 
aerated;  and  if  they  dissolve  in  these  solutions,  it  would  afford 
greater  hopes,  that  that  which  remains  in  the  bladder  might  be 
affected  by  these  medicines  taken  by  the  stomach,  or  injected 
into  the  bladder. 

To  prevent  the  increase  of  a stone  in  the  bladder  much  diluent 
drink  should  be  taken;  as  half  a pint  of  water  warmed  to  about 
eighty  degrees,  three  or  four  times  a day:  which  will  not  only 
prevent  the  growth  of  it,  by  preventing  any  microscosmic  salts 
from  being  precipitated  from  the  urine,  and  by  keeping  the  mu- 


36 


DISEASES 


Class  I.  1.  3.  10. 


cus  suspended  in  it;  but  will  also  diminish  the  stone  already 
formed,  by  softening,  and  washing  away  its  surface.  To  this 
must  be  added  cool  dress,  and  cool  bed-clothes,  as  directed  above 
in  the  calculus  renis. 

When  the  stone  is  pushed  against  or  into  the  neck  of  the  blad- 
der, great  pain  is  produced;  this  may  sometimes  be  relieved  by  the 
introduction  of  a bougie  to  push  the  stone  back  into  the  fundus  of 
the  bladder.  Sometimes  by  change  of  posture,  or  by  an  opiate 
either  taken  into  the  stomach,  or  by  a clyster. 

A dram  of  sal  soda,  or  of  salt  of  tartar,  dissolved  in  a pint  of 
water,  and  well  saturated  with  carbonic  acid  (fixed  air)  by  means 
of  Dr.  Nooth’s  glass  apparatus,  and  drunk  every  day,  or  twice  a 
day,  is  the  most  efficacious  internal  medicine  yet  discovered, 
which  can  be  easily  taken  without  any  general  injury  to  the  con- 
stitution. An  aerated  alkaline  water  of  this  kind  is  sold  under 
the  name  of  factitious  Seltzer  water,  by  J.  Schweppe,  at  No.  8, 
King’s-street,  Holborn,  London;  which  1 am  told  is  better  pre- 
pared than  can  be  easily  done  in  the  usual  glass  vessels,  probably 
by  employing  a greater  pressure  in  wooden  ones. 

A curious  account  is  given  in  a letter  to  Sir  John  Sinclair  from 
Colonel  Martin;  who  asserts,  that,  after  using  bougies  and  in- 
jections into  the  bladder,  the  passage  of  the  urethra  became  less 
sensible  to  pain,  and  he  was  enabled  to  introduce  small  files  (I 
suppose  with  their  backs  smooth;)  and  that  by  these  he  gradu- 
ally filed  away  the  stone,  as  it  lay  in  the  neck  of  the  bladder. 
When  the  stone  did  not  properly  present  itself,  he  introduced 
warm  water  by  injection  into  the  bladder,  and  thus,  by  again  en- 
deavouring to  discharge  it,  brought  forward  the  stone  to  the  neck 
of  it.  He  used  the  file  three  times  in  twenty-four  hours  from 
April  till  October.  Medical  Journal,  No.  II.  p.  121.  If  this 
process  should  be  again  attempted,  perhaps  the  file  might  be  intro- 
duced through  a flexible  canula,  with  a metallic  hood  at  the  in- 
ternal end  of  the  canula  to  cover  the  back  of  the  file,  so  as  to 
prevent  the  friction  of  it  against  the  urethra,  or  neck  of  the  blad- 
der. If  the  urethra,  by  frequent  trials,  should  become  so  insen- 
sible as  to  admit  easily  the  frequent  introduction  of  a metallic 
canula,  might  not  two  fine  steel  wires  properly  tempered  be  join- 
ed at  one  end  by  a hinge,  and  thus  introduced  through  the  canula 
into  the  bladder;  and  when  protruded  beyond  the  extremity 
of  the  canula,  they  might  open  by  their  elasticity  so  as  to  receive 
the  stone,  and  confine  it  against  the  end  of  the  canula,  by  re- 
tracting them?  The  proper  direction  of  the  wire-springs,  so  as 
to  open  when  they  are  pushed  through  the  canula,  must  be  pre- 
viously given  them.  If  this  could  be  managed,  a small  file  or 
borer  might  at  the  same  time  be  introduced  through  the  canula. 


Class.  I.  1.  3.  11. 


OF  IRRITATION. 


37 


the  handles  of  which  might  consist  of  joints  to  permit  them  to 
bend  in  all  directions,  and  thus  the  stone  might  be  broken  to 
pieces  by  a few  trials;  or  if  it  was  soft  or  fragile  stone,  the  re- 
traction of  the  wire-bow  might  divide  it  at  every  trial,  till  it  be- 
came almost  reduced  to  powder.  A little  mechanical  ingenuity 
might  be  necessary  in  the  construction  and  use  of  this  machinery; 
but  I believe  it  not  to  be  impracticable,  since  I read  the  above 
account  of  Colonel  Martin,  though  1 had  often  before  thought  of 
it  with  despair  of  its  successful  application. 

Lithotomy  is  the  last  resource.  Will  the  gastric  juice  of  ani- 
mals dissolve  calculi?  Will  fermenting  vegetable  juices,  as 
sweet-wort,  or  sugar  and  water  in  the  act  of  fermentation  with 
yeast,  dissolve  any  kind  of  animal  concretions? 

1 1 . Calculus  arthriticus.  Gout-stones  are  formed  on  inflamed 
membranes,  like  those  of  the  kidneys  above  described,  by  the 
too  hasty  absorption  of  the  thinner  and  saline  parts  of  the  mucus. 
Similar  concretions  have  been  produced  in  the  lungs,  and  even 
in  the  pericardium;  and  it  is  probable  that  the  ossification,  as  it 
is  called,  of  the  minute  arteries,  which  is  said  to  attend  old  age, 
and  to  precede  some  mortifications  of  the  extremities,  may  be  a 
process  of  this  kind. 

As  gout-stones  lie  near  the  surface,  it  is  probable,  that  ether, 
frequently  applied  in  their  early  state,  might  render  them  so  li- 
quid as  to  permit  their  re-absorption;  which  the  stimulus  of  the 
ether  might  at  the  same  time  encourage. 

12.  Rheumatismus chronicus.  Chronic  rheumatism.  After  the 
acute  rheumatism  some  inspissated  mucus,  or  material  similar  to 
chalk-stones  of  the  gout,  which  was  secreted  on  the  inflamed 
membrane,  is  probably  left,  owing  to  the  too  hasty  absorption  of 
the  thinner  and  saline  part  of  it;  and  by  laying  on  the  fascia, 
which  covers  some  of  the  muscles,  pains  them,  when  they  move 
and  rub  against  it,  like  any  extraneous  material. 

The  pain  of  the  shoulder,  which  attends  inflammations  of  (he 
upper  membrane  of  the  liver,  and  the  pains  of  the  arms,  which 
attend  asthma  dolorificum,  or  dropsy  of  the  pericardium,  are  dis- 
tinguished from  the  chronic  rheumatism,  as  in  the  latter  the  pain 
only  occurs  on  moving  the  affected  muscles. 

M.  M.  Warm  bath,  cold  bath,  bandage  of  the  emplastrum  de 
monio  put  on  tight,  so  as  to  compress  the  part.  Cover  the  part 
with  flannel.  With  oiled  silk.  Rub  it  with  common  oil  fre- 
quently. With  ether.  A blister.  A warmer  climate.  Vene- 
section. A grain  of  calomel  and  a grain  of  opium  for  ten  suc- 
cessive nights.  The  Peruvian  bark. 

13.  Cicatrix  vulnerum.  The  scar  after  wounds.  In  the 
healing  of  ulcers  the  matter  is  first  thickened  by  increasing  the 


38 


DISEASES 


Class  I.  1.  S.  14, 


absorption  in  them;  and  then  lessened,  till  all  the  matter  is  ab- 
sorbed, which  is  brought  by  the  arteries,  instead  of  being  depo- 
sited in  the  ulcer. 

M.  M.  This  is  promoted  by  a bandage,  by  sorbentia  ex- 
ternally, as  powder  of  bark,  white  lead;  solution  of  sugar  of  lead. 
And  by  the  sorbentia  internally  alter  evacuations.  See  Sect. 
XXXIII.  3.  2. 

In  those  ulcers,  which  are  made  by  the  contact  of  external 
lire,  the  violent  action  of  the  fibres,  which  occasions  the  pain,  is 
liable  to  continue,  after  the  external  heat  is  withdrawn.  This 
should  be  relieved  by  external  cold,  as  of  snow,  salt  and  water 
recently  mixed,  ether,  or  spirits  of  wine,  suffered  to  evaporate  on 
the  part. 

The  cicatrix  of  an  ulcer  generally  proceeds  from  the  edges  of 
it;  but  in  large  ones  frequently  from  the  middle,  or  commences 
in  several  places  at  the  same  time;  which  probably  contributes 
to  the  unevenness  of  large  scars. 

14.  Cornea  obfuscalio.  Opacity  of  the  cornea.  There  are 
few  people  who  have  passed  the  middle  of  life,  who  have  not  at 
some  time  suffered  some  slight  scratches  or  injuries  of  the  cornea, 
which  by  not  healing  with  a perfect  smooth  surface,  occasion 
some  refractions  of  light,  which  may  be  conveniently  seen  in  the 
following  manner:  fill  a tea-saucer  with  cream  and  tea,  or  with 
milk,  and  holding  it  to  your  lips,  as  if  going  to  drink  it,  the  im- 
perfections of  the  cornea  will  appear  like  lines  or  blotches  on  the 
surface  of  the  fluid,  with  a less  tvhite  appearance  than  that  sur- 
face. Those  blemishes  of  the  eye  are  distinguished  from  the 
muscas  volitantes  described  in  Class  I.  2.  5.  3.  by  their  being  in- 
variably seen  at  any  time  w'hen  you  look  for  them. 

Ulcers  may  frequently  be  seen  on  the  cornea  after  ophthal my, 
like  little  pits  or  indentations  beneath  the  surface  of  it;  in  this 
case  no  external  application  should  be  used,  lest  the  scar  should 
be  left  uneven;  but  the  cure  should  be  confined  to  the  internal 
use  of  thirty  grains  of  bark  twice  a day,  and  from  five  to  ten 
drops  of  laudanum  at  night,  with  five  grains  of  rhubarb,  if 
necessary. 

After  ulcers  of  the  cornea,  which  have  been  large,  the  ine- 
qualities and  opacity  of  the  cicatrix  obscure  the  sight:  in  this 
case,  could  not  a small  piece  of  the  cornea  be  cut  out  by  a kind 
of  trephine  about  the  size  of  a thick  bristle,  or  a small  crow- 
quill,  and  would  it  not  heal  with  a transparent  scar?  This  expe- 
riment is  worth  trying,  and  might  be  done  by  a piece  of  hollow 
steel  wire  with  a sharp  edge,  through  which  might  be  introduced 
a pointed  steel  screw;  the  screw  to  be  introduced  through  the 
opaque  cornea  to  hold  it  up,  and  press  it  against  the  cutting  edge 


Class  I.  1.  3.  14. 


OF  IRRITATION. 


39 


of  the  hollow  wire  or  cylinder;  if  the  scar  should  heal  without 
losing  its  transparency,  many  blind  people  might  be  made  to  see 
tolerably  well  by  this  slight  and  not  painful  operation.  An  ex- 
periment I wish  strongly  to  recommend  to  some  ingenious  sur- 
geon or  oculist. 

Or  it  may  be  attempted  by  pressing  one  end  of  a small  canula 
on  the  centre  of  the  cornea,  and  passing  down  it  a bit  of  luna 
cornea,  fixed  in  the  end  of  a smaller  canula,  and  thus  introdu- 
ced: the  eye  may  be  held  steady  by  passing  a thread  by  means 
of  a small  curved  needle  through  a part  of  the  tunica  adjuncti- 
va,  which  may  be  held  by  an  assistant,  or  by  pressing  on  it  the 
end  of  the  canula  as  above,  which  might  have  a fiat  circular  rim 
round  its  extremity  for  that  purpose. 


40 


DISEASES 


Class  I.  1.  4.  1 


ORDO  I. 

f 

Increased  Irritation. 

GENUS  IV. 

With  increased  Actions  of  other  Cavities  and  Membranes. 


SPECIES. 

1.  Niditatio  irritativa.  Winking  of  the  eyes  is  performed 
every  minute  without  our  attention,  for  the  purpose  ot  cleaning 
and  moistening  the  eye-ball;  as  further  spoken  of  in  Class  II.  1. 
1.  8.  When  the  cornea  becomes  too  dry,  it  becomes  at  the  same 
time  less  transparent;  which  is  owing  to  the  pores  of  it  being 
then  too  large,  so  that  the  particles  of  light  are  refracted  by  the 
edges  of  each  pore,  instead  of  passing  through  it;  in  the  same 
manner  as  light  is  refracted  by  passing  near  the  edge  of  a knife. 
When  these  pores  are  filled  with  water,  the  cornea  becomes 
again  transparent.  This  want  of  transparency  of  the  cornea  is 
visible  sometimes  in  dying  people,  owing  to  their  inirritability, 
and  consequent  neglect  of  nictitation. 

The  increase  of  transparency  by  filling  the  pores  with  fluid  is 
seen  by  soaking  white  paper  in  oil;  which  from  an  opaque  body 
becomes  very  transparent,  and  accounts  for  a curious  atmosphe- 
ric phenomenon;  when  there  exists  a dry  mist  in  a morning  so  as 
to  render  distant  objects  less  distinct,  it  is  a sign  of  a dry  day; 
when  distant  objects  are  seen  very  distinct  it  is  a sign  of  rain. 
See  Botan.  Garden,  Part  I.  add.  note  xxv.  The  particles  of  air 
are  probably  larger  than  those  of  water,  as  water  will  pass 
through  leather  and  paper,  which  will  confine  air,  hence  when 
the  atmosphere  is  much  deprived  of  moisture,  the  pores  of  the 
dry  air  are  so  large,  that  the  rays  of  light  are  refracted  by  their 
edges  instead  of  passing  through  them.  But  when  as  much  mois- 
ture is  added  as  can  be  perfectly  dissolved,  the  air  becomes  trans- 
parent; and  opaque  again,  when  a part  of  this  moisture  collects 
into  small  spherules  previous  to  its  precipitation.  This  also  ac- 
counts for  the  want  of  transparency  of  the  air,  which  is  seen  in 
tremulous  motions  over  corn-fields  on  hot  summer-days,  or  over 
brick-kilns,  after  the  flame  is  extinguished,  while  the  furnace 
remains  hot. 

2.  Deglutitio  irritativa.  The  deglutition  of  our  saliva  is  per- 
formed frequently  without  our  attention,  and  is  then  an  irritative 
action  in  consequence  of  the  stimulus  of  it  in  the  mouth.  Or 


Class  I.  1.4.  3. 


OF  IRRITATION. 


41 


perhaps  sometimes  for  the  purpose  of  diffusing  a part  of  it  over 
the  dry  membranes  of  the  fauces  and  pharynx;  in  the  same 
manner  as  tears  are  diffused  over  the  cornea  of  the  eye  by  the  act 
of  nictitation  to  clean  or  moisten  it. 

3.  Respiratio  et  Tussis  irritativce.  In  the  acts  of  respiration 
and  of  coughing  there  is  an  increased  motion  of  the  air-cells  of 
the  lungs  owing  to  some  stimulating  cause,  as  described  above  in 
Class  I.  1.2.  8.  and  I.  1.3.  4.  and  which  are  frequently  per- 
formed without  our  attention  or  consciousness,  and  are  then  irri- 
tative actions;  and  thus  differ  from  those  described  in  Class  II. 
1.  1.2.  and  5.  To  these  increased  actions  of  the  air-cells  are 
superadded  those  of  the  intercostal  muscles  and  diaphragm  by 
irritative  association.  When  any  unnatural  stimulus  acts  so  vio- 
lently on  the  organs  of  respiration  as  to  induce  pain;  the  senso- 
rial power  of  sensation  becomes  added  to  that  of  irritation,  and 
inflammation  of  the  membranes  of  them  is  a general  consequence. 

4.  Exclusio  bilis.  The  exclusion  of  the  bile  from  the  gall-blad- 
der, and  its  derivation  into  the  duodenum,  is  an  irritative  action 
in  consequence  of  the  stimulus  of  the  aliment  on  the  extremity 
of  the  biliary  duct,  which  terminates  in  the  intestine.  The  in- 
creased secretion  of  tears  is  occasioned  in  a similar  manner  by  any 
stimulating  material  in  the  eyes;  which  affects  the  excretory 
ducts  of  the  lachrymal  glands.  A pain  of  the  external  membrane 
of  the  eye  sometimes  attends  any  unusual  stimulus  of  it,  then  the 
sensorial  power  of  sensation  becomes  added  to  that  of  irritation, 
and  a superficial  inflammation  is  induced. 

5.  Dentitio.  Toothing.  The  pain  of  toothing  often  begins 
much  earlier  than  is  suspected;  and  is  liable  to  produce  convul- 
sions; which  are  sometimes  relieved,  when  the  gum  swells,  and 
becomes  inflamed;  at  other  times  a diarrhoea  supervenes,  which 
is  generally  esteemed  a favourable  circumstance,  and  seems  to 
prevent  the  convulsions  by  supplying  another  means  of  relieving 
the  pain  of  dentition  by  irritative  exertion;  and  a consequent 
temporary  exhaustion  of  sensorial  power.  See  Class  I.  1.2.  5. 
Sect.  XXXY.  2.  1. 

The  convulsions  from  toothing  generally  commence  long  be- 
fore the  appearance  of  the  teeth;  but  as  the  two  middle  incisors 
of  the  lower  jaw  generally  appear  first,  and  then  those  of  the 
upper,  it  is  advisable  to  lance  the  gums  over  these  longitudinally 
in  respect  to  the  jaw-bones,  and  quite  down  to  the  periosteum, 
and  through  it. 

As  the  convulsions  attending  the  commencement  of  toothing  are 
not  only  dangerous  to  life  in  their  greatest  degree,  but  are  liable  to 
induce  stupor  or  insensibility  by  their  continuance  even  in  a less 
degree,  the  most  efficacious  means  should  be  used  to  cure  them. 

VOL.  II.  g 


42 


DISEASES 


Class  I.  1.  4.  6. 


M.  M.  Lance  the  gum  of  the  expected  teeth  quite  through  the 
periosteum  longitudinally.  Venesection  by  the  lancet  or  by  two 
or  three  leeches.  One  grain  of  calomel  as  a purge.  Tincture  of 
jalap,  five  or  six  drops  in  water  every  three  hours  till  it  purges, 
to  be  repeated  daily.  After  evacuations  a small  blister  on  the 
back  or  behind  the  ears.  And  lastly  two  or  three  drops  of  lauda- 
num according  to  the  age  of  the  child.  Warm-bath.  See  Class 
III.  1.  1.  5.  and  6. 

6.  Priapismus  chronicus.  I have  seen  two  cases  where  an 
erection  of  the  penis,  as  hard  as  horn,  continued  two  or  three 
weeks  without  any  venereal  desires,  but  not  without  some  pain; 
the  easiest  attitude  of  the  patients  was  lying  upon  their  backs 
with  their  knees  up.  At  length  the  corpus  cavernosum  urethrae 
became  soft,  and  in  another  day  or  two  the  whole  subsided.  In 
one  of  them  a bougie  was  introduced,  hoping  to  remove  some 
bit  of  gravel  from  the  caput  gallinaginis,  camphor,  warm  bathing, 
opium,  lime-water,  cold  aspersion,  bleeding  in  the  veins  of  the 
penis,  were  tried  in  vain.  One  of  them  had  been  a free  drinker, 
had  much  gutta  rosacea  on  his  face,  and  died  suddenly  a few 
months  after  his  recovery  from  this  complaint.  Was  it  a para- 
lysis of  the  terminations  of  the  veins,  which  absorb  the  blood 
from  the  tumid  penis?  or  from  the  stimulus  of  indurated  semen 
in  the  seminal  vessels?  In  the  latter  case  some  venereal  desires 
should  have  attended.  Class  III.  1.  2.  16. 

The  priapismus,  which  occurs  to  vigorous  people  in  a morn- 
ing before  they  awake,  has  been  called  the  signum  salutis,  or 
banner  of  health,  and  is  occasioned  by  the  increase  of  our  irritability 
or  sensibility  during  sleep,  as  explained  in  Sect.  XVIII.  15. 

7.  Distentio  mammularuni.  The  distention  of  the  nipples  of 
lactescent  women  is  first  owing  to  the  stimulus  of  the  milk.  See 
Sect.  XIV.  8.  and  Sect.  XVI.  5.  See  Class  II.  1.  7.  10. 

8.  Descensus  uteri.  This  is  a very  frequent  complaint  after 
bad  labours,  the  fundus  uteri  becomes  inverted,  and  descends 
like  the  prolapsus  ani. 

M.  M.  All  the  usual  pessaries  are  very  inconvenient  and  in- 
effectual. A piece  of  soft  sponge  about  two  inches  diameter  in- 
troduced into  the  vagina  gives  great  ease  to  these  patients,  and 
supports  the  uterus;  it  should  have  a string  put  through  it  to 
retract  it  by. 

There  are  also  pessaries  now  made  of  elastic  gum,  which  are- 
said  to  be  easily  worn,  and  to  be  convenient  from  their  having  a 
perforation  in  their  centre. 

9.  Prolapsus  ani.  The  lower  part  of  the  rectum  becomes  in- 
verted, and  descends  after  every  stool  chiefly  in  children;  and 
thus  stimulates  the  sphincter  ani  like  any  other  extraneous  body 


Class  I.  1.  4.  10. 


OP  IRRITATION. 


43 


M.  M.  It  should  be  dusted  over  with  very  fine  powder  of  gum 
sandarach,  and  then  replaced.  Astringent  fomentations;  as  an 
infusion  of  oak  bark  or  a slight  solution  of  alum.  Horizontal 
rest  frequently  in  the  day. 

10.  Lumbricus.  Round  worm.  The  round  worm  is  sus- 
pected in  children  when  the  belly  is  tumid,  and  the  countenance 
bloated  and  pale,  with  swelling  of  the  upper  lip.  The  genera- 
tion of  these  worms  is  promoted  by  the  too  dilute  state  of  the 
bile,  as  is  evident  in  the  fluke-worm  found  in  the  biliary  ducts 
and  substance  of  the  liver  in  sheep;  and  in  water-rats,  in  the 
livers  of  which  last  animals  they  were  lately  detected  in  large 
numbers  by  Dr.  Capelle.  Transactions  of  the  College  at  Phila- 
delphia, v.  i. 

Now  as  the  dilute  state  of  the  bile  depends  on  the  deficiency 
of  the  absorption  of  its  thinner  parts;  it  appears  that  the  tumid 
belly  and  bloated  countenance,  and  swelled  upper  lip,  are  con- 
comitant circumstances  attending  the  general  inactivity  of  the 
absorbent  system;  which  is  therefore  to  be  esteemed  the  remote 
cause  of  the  generation  of  worms. 

The  simplicity  of  the  structure  of  worms  probably  enables 
them  to  exist  in  more  various  temperatures  of  heat;  and  their 
being  endued  with  life  prevents  them  from  being  destroyed  by 
digestion  in  the  stomach,  probably  in  the  same  manner  as  the 
powers  of  life  prevent  the  fermentation  and  putrefaction  of  the 
stomach  itself.  Hence  I conclude  that  worms  are  originally 
taken  into  our  alimentary  canal  from  without;  as  I believe  simi- 
lar worms  of  all  kinds  are  to  be  found  out  of  the  body. 

M.  M.  The  round  worm  is  destroyed  by  a cathartic  with 
four  or  six  grains  of  calomel;  and  afterwards  by  giving  six  or 
eight  grains  of  filings  of  iron  twice  a day  for  a fortnight.  See 
Hepatis  tumor,  Class  I.  2.  3.  9.  As  worms  are  liable  to  come 
away  in  fevers,  whether  of  the  hectic  or  putrid  kind,  could  they 
be  removed  by  purulent  matter,  or  rotten  egg,  or  putrid  flesh, 
since  in  those  fevers  from  the  enfeebled  action  of  the  intestines 
the  faeces  become  highly  putrid? 

The  sharp  spiculae  or  hairs,  which  are  found  on  the  pods  of 
cowhage,  stizolobium  siliqua  hirsuta,  have  been  recommended 
in  worm-cases,  and  said  to  destroy  them  by  mechanical  puncture; 
the  late  Mr.  Power  of  Polesworth,  assured  me,  he  had  had  great 
success  with  this  medicine,  and  gave  about  six  or  eight  grains  in 
a bolus  three  or  four  times  on  one  day,  with  a brisk  cathartic 
on  the  next  day.  Some  have  recommended  chopped  hair  or 
bristles  for  this  purpose.  There  are  numerous  sharp  spiculae  in 
the  fruit  of  the  wild  rose,  which  might  be  worth  trying  in  this 


44 


DISEASES 


Class  I.  1,  4.  11. 


disease,  and  the  hairs  on  full  grown  hairy  caterpillars,  if  the  ani- 
mal be  laid  on  the  hand,  especially  between  the  fingers,  are  liable 
to  stick  in  the  skin,  and  to  produce  slight  inflammation  and  itch- 
ing, and  might  also  be  worth  trying  in  worm-cases.  But  it  is 
asserted  in  M.  Vaillant’s  Travels  in  Africa,  that  when  these  in- 
sects feed  on  poisonous  plants,  they  become  themselves  so  veno- 
mous, that  the  natives  collect  a juice  from  them,  with  which 
when  putrid  they  smear  their  war-weapons  to  poison  them. 

11.  Tania.  Tape-worm  consists  of  a chain  of  animals  ex- 
tending from  the  stomach  to  the  anus.  See  Sect.  XXXIX.  2.  3. 
It  frequently  exists  in  cats,  rats,  and  geese,  and  probably  in  many 
other  animals. 

The  worms  of  this  genus  possess  a wonderful  power  of  re- 
taining life.  Two  of  them,  which  were  voided  by  a pointer 
dog  in  consequence  of  violent  purgatives,  each  of  which  was 
several  feet  in  length,  had  boiling  water  poured  on  them  in  a 
basin;  which  seemed  not  much  to  inconvenience  them.  When 
the  water  was  cool,  they  were  taken  out  and  put  into  gin  or 
whiskey  of  the  strongest  kind,  in  which  their  life  and  activity 
continued  unimpaired;  and  they  w'ere  at  length  killed  by  adding 
to  the  spirit  a quantity  of  corrosive  sublimate.  Medio.  Com- 
ment. for  1791,  p.  370. 

The  tape-worm  is  cured  by  an  amalgama  of  tin  and  quicksilver, 
such  as  is  used  on  the  back  of  looking-glasses;  an  ounce  should 
be  taken  every  two  hours,  till  a pound  is  taken;  and  then  a brisk 
cathartic  of  Glauber’s  salt  two  ounces,  and  common  salt  one 
ounce,  dissolved  in  two  wine  pints  of  water,  half  a pint  to  be  taken 
every  hour  iill  it  purges.  The  worm  extends  from  the  stomach 
to  the  anus,  and  the  amalgama  tears  it  from  the  intestine  by  me- 
chanical pressure,  acting  upon  it  the  whole  way.  Electric  shocks 
through  the  duodenum  greatly  assists  the  operation.  Large  doses 
of  tin  in  powder.  Iron  filings  in  large  doses.  The  powder  of 
fern  root  seems  to  be  of  no  use,  as  recommended  by  M.  Nouf- 
flier.  This  worm,  as  well  as  the  lumbricus  or  round-worm,  is 
sometimes  brought  up  by  vomiting;  when  either  of  these  worms 
is  in  the  stomach  it  gives  a tickling  sensation  about  the  fauces, 
which  parts  sympathize  with  the  cardia  ventriculi.  See  Annals 
of  Medicine,  1797.  Give  an  emetic  of  tartarized  antimony,  or 
of  vitriol  of  zinc. 

12.  Ascarides.  Thread  worms.  These  worms  are  said  to  be  more 
frequent  in  some  parts  of  this  kingdom  than  in  others,  as  near 
the  fens  of  Lincolnshire.  Do  they  escape  from  the  body  and  be- 
come flies,  like  the  bott-worm  in  horses?  Do  they  crawl  from 
one  child  to  another  in  the  same  bed?  Are  they  acquired  from 
flies  or  worms,  which  are  seenTn  putrid  necessary  houses,  as 


CiassI.  1. 4.  12. 


OP  IRRITATION. 


45 


these  worms  as  well  as  the  tape-worms,  are  probably  acquired 
from  without?  this  may  account  for  their  re-appearance  a few 
weeks  or  months  after  they  have  been  destroyed;  or  can  this 
happen  from  the  eggs  or  parts  of  them  remaining? 

Ascarides  appear  to  be  of  two  kinds,  the  common  small  one 
like  a thread;  which  has  a very  sharp  head,  as  appears  in  the  mi- 
croscope; and  which  is  so  tender,  that  the  cold  air  soon  renders 
it  motionless;  and  a larger  kind  above  an  inch  long,  and  nearly 
as  thick  as  a very  small  crow-quill,  and  which  is  very  hard  in  re- 
spect to  its  texture,  and  very  tenacious  of  life.  One  of  these  last 
was  brought  to  me,  and  was  immediately  immersed  in  a strong 
solution  of  sugar  of  lead,  and  lived  in  it  a very  long  time  without 
apparent  inconvenience. 

M.  M.  Ascarides  are  said  to  be  weakend  by  twenty  grains 
of  cinnabar  and  five  of  rhubarb  taken  every  night,  but  not  to  be 
cured  by  this  process.  As  these  worms  are  found  only  in  the 
rectum,  variety  of  clysters  have  been  recommended.  A clyster 
consisting  of  one  eighth  or  one  fourth  of  an  ounce  of  siccotrine 
aloes  in  powder  boiled  in  a pint  of  milk  or  of  gruel,  till  it  is  dis- 
solved, and  injected  once  a week  for  many  weeks,  I believe  has 
sometimes  effected  a cure.  I was  informed  of  a case,  where  so- 
lutions of  mercurial  ointment  were  used  as  a clyster  every  night 
for  a month  without  success.  Clysters  of  Harjowgate  water  are 
recommended  either  of  the  natural,  or  of  the  factitious,  as  de- 
scribed below,  which  might  have  a greater  proportion  of  liver 
of  sulphur  in  it.  As  the  cold  air  soon  destroys  them,  after  they 
are  voided,  could  clysters  of  iced  water  be  used  with  advantage? 
or  of  spirit  of  wine  and  water?  or  of  ether  and  water?  Might 
nor  a piece  of  candle,  about  an  inch  long,  or  two  such  pieces, 
smeread  with  mercurial  ointment,  and  introduced  into  the  anus 
at  night  or  twice  a day,  be  effectual  by  compressing  their  nidus, 
as  well  as  by  the  poison  of  the  mercury? 

The  clysters  should  be  in  large  quantity,  that  they  may  pass 
high  in  the  rectum,  as  two  drams  of  tobacco  boiled  a minute  in 
a pint  of  water.  Or  perhaps  what  might  be  still  more  effica- 
cious and  less  inconvenient,  the  smoke  of  tobacco  injected  by 
a proper  apparatus  every  night,  or  alternate  nights,  for  six  or 
eight  weeks.  This  was  long  since  recommended,  I think,  by 
Mr.  Turner  of  Liverpool;  and  the  reason  it  has  not  succeeded, 
I believe  to  have  been  owing  to  the  imperfections  of  the  joints 
of  the  common  apparatus  for  injecting  the  smoke  of  tobacco,  so 
that  it  did  not  pass  into  the  intestine,  though  it  was  supposed  to 
do  so,  as  I once  observed.  The  smoke  should  be  reoeived  from 
the  apparatus  into  a large  bladder;  and  it  may  then  be  certainly 
injected  like  the  common  clyster  with  sufficient  force;  otherwise 


46 


DISEASES 


Class  I.  1.  4. 13. 


oiled  leathers  should  be  nicely  put  round  the  joints  of  the  ma- 
chine; and  a wet  cloth  round  the  injecting  pipe  to  prevent  the 
return  of  the  smoke  by  the  sides  of  it.  Clysters  of  carbonated 
hydrogen  gas,  or  of  other  factitious  airs,  might  be  tried;  or  of 
the  hairs  of  siliqua  hirsuta. 

Harrowgate  water  taken  into  the  stomach,  so  as  to  induce  six 
or  seven  stools  every  morning,  for  four  or  six  weeks,  is  perhaps 
the  most  efficacious  method  in  common  use.  A factitious  Har- 
rowgate water  may  be  made  probably  of  greater  efficacy  than 
the  natural,  by  dissolving  one  ounce  of  marine  salt,  (called  bay 
salt,)  and  half  an  ounce  of  magnesia  Glauber’s  salt,  (called  Ep- 
som salt,  or  bitter  purging  salt,)  in  twenty-eight  ounces  of  water. 
A quarter  or  half  a pint  of  this  is  to  be  taken  every  hour,  or  two 
hours  in  the  morning,  till  it  operates;  with  a tea-spoonful  of  a 
solution  of  liver  of  sulphur,  which  is  to  be  made  by  putting  an 
ounce  of  hepar  sulphuris  into  half  a pint  of  water.  See  Class 
IV.  1.  2.  9. 

13.  Drucunculus.  A thin  worm  brought  from  the  coast  of 
Guinea.  It  is  found  in  the  interstices  of  the  muscles,  and  is 
many  yards  long;  it  makes  a small  ulcer;  which  is  cured  by 
extracting  an  inch  of  the  worm  a day,  and  wrapping  the  extract- 
ed part  slowly  round  a bit  of  tobacco-pipe  till  next  day,  so  as  not 
to  break  it.  I have  twice  seen  long  worms,  like  a thick  horse- 
hair, in  the  water  in  July  in  this  country,  which  appeared  hard 
and  jointed. 

14.  Morpiones.  Crab-lice.  The  excrement  of  this  animal 
stains  the  linen,  and  appears  like  diluted  blood. 

M.  M.  Spirit  of  wine.  Mercurial  ointment,  shaving  the  part. 
Oil  destroys  other  insects,  if  they  be  quite  covered  with  it,  as  the 
ticks  on  dogs,  and  would  probably  therefore  destroy  these.  Its 
manner  of  operation  is  by  stopping  up  or  filling  their  spiracula, 
or  breathing  pores;  a few  drops  of  oil  poured  on  a wasp,  so  as  to 
cover  it,  destroy  it  in  a few  seconds. 

15.  Pediculi.  Lice.  There  is  said  to  be  a disease  in  which 
these  animals  are  propagated  in  indestructible  numbers,  so  as 
to  destroy  the  patient. 

M.  M.  Cleanliness,  mercurial  ointment,  stavis  acria  in  pow- 
der, or  the  tincture  of  it  in  spirit  of  wine.  Spirit  of  wine  alone? 
Bath  of  oil? 


Ciass  1. 1.  5.  1. 


OF  IRRITATION. 


47 


ORDO  I. 

Increased  Irritation. 

GENUS  V. 

IVith  increased  Actions  of  the  Organs  of  Sense. 

SPECIES. 

1.  Vis^us  acrior.  Acuter  sight.  There  have  been  instances  of 
people,  who  could  see  better  in  the  gloom  of  the  evening,  than  in 
the  stronger  light  of  the  day;  like  owls,  and  bats,  and  many  qua- 
drupeds, and  flying  insects.  When  the  eye  is  inflamed,  great 
light  becomes  eminently  painful,  owing  to  the  increased  irrita- 
tive motions  of  the  retina,  and  the  consequent  increased  sensation. 
Thus  when  the  eye  is  dazzled  with  sudden  light,  the  pain  is  not 
owing  to  the  motion  of  the  iris;  for  it  is  the  contraction  of  the 
iris,  which  relieves  the  pain  from  sudden  light;  but  to  the  too 
violent  contractions  of  the  moving  fibres,  which  constitute  the  ex- 
tremities of  the  optic  nerve. 

2.  Auditus  acrior.  The  irritative  ideas  of  hearing  are  so  in- 
creased in  energy  as  to  excite  our  attention.  This  happens  in 
some  diseases  of  the  epileptic  kind,  and  in  some  fevers.  Hence 
the  whispering  of  the  currents  of  air  in  a room,  the  respiration  of 
the  company,  and  noises  before  unperceived,  become  trouble- 
some; and  sounds  louder  than  usual,  or  unexpected,  produce  start- 
ing and  convulsions. 

M.  M.  Put  oil  of  almonds  into  the  ears.  Stop  the  meatus 
auditorius  with  cotton  wool.  Set  the  feet  of  the  patient’s  bed 
on  cushions,  or  suspend  it  by  cords  from  the  ceiling. 

3.  Olfactus  acrior.  The  irritative  ideas  of  smell  from  the  in- 
creased action  of  the  olfactive  nerve  excite  our  attention.  Hence 
common  odours  are  disagreeable;  and  are  perceived  from  variety 
of  objects,  which  were  before  thought  inodorous.  These  are 
commonly  believed  to  be  hallucinations  of  the  sense. 

M.  M.  Snuff  starch  up  the  nostrils. 

4.  Gustus  acrior.  The  irritative  ideas  of  taste,  as  of  our  own 
saliva,  and  even  of  the  atmospheric  air,  excite  our  attention;  and 
common  tastes  are  disagreeably  strong. 

M.  M.  Water.  Mucilage.  Vegetable  acids.  Scrape  the  tongue 
clean.  Rub  it  with  a sage-leaf  and  vinegar. 

5.  T actus  acrior.  The  irritative  ideas  of  the  nerves  of  touch 


48 


DISEASES 


Class  T.  1.  5.  6. 


excite  our  attention:  hence  our  own  pressure  on  the  parts,  we 
rest  upon,  becomes  uneasy  with  universal  soreness. 

M.  M.  Soft  feather-bed.  Combed  wool  put  under  the  patients, 
which  rolls  under  them,  as  they  turn,  and  thus  prevents  their  fric- 
tion against  the  sheets.  Drawers  of  soft  leather.  Plasters  of 
cerate  with  calamy. 

6.  Sensus  colons  acrior.  Acuter  sense  of  heat  occurs  in  some 
diseases,  and  that  even  when  the  perceptible  heat  does  not  appear 
greater  than  natural  to  the  hand  of  another  person.  See  Class  I. 
1.  2.  See  Sect.  XIV.  8.  All  the  above  increased  actions  of  our 
organs  of  sense  separately  or  jointly  accompany  some  fevers,  and 
some  epileptic  diseases;  the  patients  complaining  of  the  percep- 
tion of  the  least  light,  noises  in  their  ears,  bad  smells  in  the  room, 
and  bad  tastes  in  their  mouths,  with  soreness,  numbness,  and 
other  uneasy  feels,  and  with  disagreeable  sensations  of  general  oi 
partial  heat. 

7.  Sensus  extensionis  acrior.  Acuter  sense  of  extension.  The 
sense  of  extension  was  spoken  of  in  Sect.  XIV.  7.  and  XXXII.  4. 
The  defect  of  distention  in  the  arterial  system  is  accompanied 
with  faintness;  and  its  excess  with  sensations  of  fulness,  or  weight, 
or  pressure.  This  however  refers  only  to  the  vascular  muscles, 
which  are  distended  by  their  appropriated  fluids;  but  the  longi- 
tudinal muscles  are  also  affected  by  different  quantities  of  exten- 
sion, and  become  violently  painful  by  the  excess  of  it. 

These  pains  of  muscles  and  of  membranes  are  generally  divid- 
ed into  acute  and  dull  pains.  The  former  are  generally  owing 
to  increase  of  extension,  as  in  pricking  the  skin  with  a needle; 
and  the  latter  generally  to  defect  of  extension,  as  in  cold  head- 
aches; but  if  the  edge  of  a knife,  or  point  of  a pin,  be  gradually 
pressed  against  the  fibres  of  muscles  or  membranes  there  would 
seem  to  be  three  states  or  stages  of  this  extension  of  the  fibres; 
which  have  acquired  names  according  to  the  degree  or  kind  of 
sensation  produced  by  the  extension  of  them;  these  are,  1.  titil- 
lation  or  tickling;  2.  itching;  and  the  3.  smarting,  as  described 
below.  See  Sect.  XIV.  9. 

2.  Tilillatio.  Tickling  is  a pleasurable  pain  of  the  sense  of 
extension  above  mentioned,  and  therefore  excites  laughter;  as 
described  in  Sect.  XXXIV.  1.  4.  The  tickling  of  the  nostrils, 
which  precedes  the  efforts  of  sneezing,  is  owing  to  the  increased 
irritation  occasioned  by  external  stimulus;  and  is  attended  with 
a pleasurable  sensation  in  consequence  of  the  increased  action  of 
the  part.  When  this  action  is  exerted  in  a greater  degree,  the 
sensation  becomes  painful,  and  the  convulsion  of  sneezing  ensues; 
as  the  pain  in  tickling  the  soles  of  the  feet  of  children  is  relieved 
by  laughter. 


'Class  I.  1.  5.  9. 


OF  IRRITATION. 


49 


A lady  after  a bruise  on  her  nose  by  a fall  was  affected  with 
incessant  sneezing,  and  relieved  by  snuffing  starch  up  her  nostrils. 
Perpetual  sneezings  in  the  measles,  and  in  catarrhs  from  cold, 
are  owing  to  the  stimulus  of  the  saline  part  of  the  mucous  effu- 
sion on  the  membrane  of  the  nostrils.  See  Class  II.  1.  1.2. 

9.  Pruritus.  Itching  seems  to  be  a greater  degree  of  titilla- 
tion,  and  to  be  owing  to  the  stimulus  of  some  acrid  material,  as 
the  matter  of  the  itch;  or  of  the  herpes  on  the  scrotum,  and 
about  the  anus;  or  from  those  universal  eruptions,  which  attend 
some  elderly  people,  who  have  drunk  much  vinous  spirit.  It. 
occurs  also,  when  inflammations  are  declining,  as  in  the  healing 
of  blisters,  or  in  the  cure  of  ophthalmia,  as  the  action  of  the  ves- 
sels is  yet  so  great  as  to  produce  sensation;  which,  like  the  titil- 
lations  that  occasion  laughter,  is  perpetually  changing  from  plea- 
sure to  pain. 

When  the  natural  efforts  of  scratching  do  not  relieve  the  pain 
of  itching,  it  sometimes  increases  so  as  to  induce  convulsions  and 
madness.  As  in  the  furor  uterinus,  and  satyriasis,  and  in  the 
sphincter  ani  and  scrotum.  See  Class  II.  1.  4.  14.  IV.  2.  2.  6. 

M.  M.  Warm  bath.  Fomentation.  Alcohol  externally. 
Poultice.  Oiled  silk.  Mercurial  ointments  on  small  surfaces 
at  once.  See  Class  II.  1.  4.  12.  Solutions  of  lead  on  small 
surfaces  at  once. 

10.  Dolor  urens.  Smarting  follows  the  edge  of  a knife  in  mak- 
ing a wound,  and  seems  to  be  owing  to  the  distention  of  a part 
of  a fibre,  till  it  breaks.  A smarting  of  the  skin  is  liable  to  af- 
fect the  scars  left  by  herpes  or  shingles;  and  the  callous  parts  of 
the  bottoms  of  the  feet;  and  around  the  bases  of  corns  on  the 
toes;  and  frequently  extends  after  sciatica  along  the  outside  of 
the  thigh,  and  of  the  leg,  and  part  of  the  foot.  All  these  may 
be  owing  to  the  stimulus  of  extension,  by  blood  or  serum  being 
forced  into  vessels  nearly  coalesced. 

M.  M.  Emplastrum  de  minio  put  like  a bandage  on  the  part. 
Warm  fomentation.  Oil  and  camphor  rubbed  on  the  part.  Oil- 
silk  covering.  A blister  on  the  part.  Ether,  or  alcohol,  suffer- 
ed to  evaporate  on  the  part. 

1 1 . Consternatio.  Surprise.  As  our  eyes  acquaint  us  at  the 
same  time  with  less  than  half  of  the  objects,  which  surround  us, 
we  have  learned  to  confide  much  in  the  organ  of  hearing  to  warn 
us  of  approaching  dangers.  Hence  it  happens,  that  if  any  sound 
strikes  us,  which  we  cannot  immediately  account  for,  our  fears 
are  instantly  alarmed.  Thus  in  great  debility  of  body,  the  loud 
clapping  of  a door,  or  the  fall  of  a fire-shovel,  produces  alarm, 
and  sometimes  even  convulsions;  the  same  occurs  from  unex- 
pected sights,  and  in  the  dark  from  unexpected  objects  of  touch, 

VOL.  II.  h 


so 


DISEASES 


Class  I.  1.  5.  11. 


In  these  cases  the  irritability  is  less  than  natural,  though  it  is 
erroneously  supposed  to  be  greater;  and  the  mind  is  busied  in 
exciting  a train  of  ideas  inattentive  to  external  objects;  when 
this  train  of  ideas  is  dissevered  by  any  unexpected  stimulus,  sur- 
prise is  excited;  as  explained  in  Sect.  XVII.  3.  7.  and  XVIII. 
17.  then  as  the  sensibility  in  these  cases  is  greater,  fear  becomes 
superadded  to  the  surprise;  and  convulsions  in  consequence  of 
the  pain  of  fear.  See  Sect.  XIX.  2. 

The  proximate  cause  of  surprise  is  the  increased  irritation  in- 
duced by  some  violent  stimulus,  which  dissevers  our  usual  trains 
of  ideas;  but  in  diseases  of  inirritability  the  frequent  starting  or 
surprise  from  sounds  not  uncommon,  but  rather  louder  than 
usual,  as  the  clapping  of  a door,  shews  that  the  attention  of  the 
patient  to  a train  of  sensitive  ideas  was  previously  stronger  than 
natural,  and  indicates  an  incipient  delirium;  which  is  therefore 
worth  attending  to-  in  febrile  diseases. 


Class  I.  2.  1. 


OF  IRRITATION, 


31 


ORDO  II. 

Decreased  Irritation. 

GENUS  I. 

With  decreased  Action  of  the  Sanguiferous  System . 

The  reader  should  be  here  apprized,  that  the  words  strength 
and  debility,  when  applied  to  animal  motions,  may  properly  ex- 
press the  quantity  of  resistance  such  motions  may  overcome;  but 
that,  when  they  are  applied  to  mean  the  susceptibility  or  insus- 
ceptibility of  animal  fibres  to  motion,  they  become  metaphorical 
terms;  as  in  Sect.  XII.  2.  1.  and  would  be  better  expressed  by 
the  words  activity  and  inactivity. 

There  are  three  sources  of  animal  inactivity;  first,  the  defect 
of  the  natural  quantity  of  stimulus  on  those  fibres,  which  have 
been  accustomed  to  perpetual  stimulus;  as  the  arterial  and  se- 
cerning systems.  When  their  accustomed  stimulus  is  for  a 
while  intermitted,  as  when  snow  is  applied  to  the  skin  of  the 
hands,  an  accumulation  of  sensorial  power  is  produced;  and  then 
a degree  of  stimulus,  as  of  heat,  somewhat  greater  than  that  at 
present  applied,  though  much  less  than  the  natural  quantity,  ex- 
cites the  vessels  of  the  skin  into  violent  action.  We  must  ob- 
serve, that  a deficiency  of  stimulus  in  those  fibres,  which  are  not 
subject  to  perpetual  stimulus,  as  the  locomotive  muscles,  is  not 
succeeded  by  accumulation  of  sensorial  power;  these  therefore 
are  more  liable  to  become  permanently  inactive  after  a diminution 
of  stimulus;  as  in  strokes  of  the  palsy,  this  may  be  called  inac- 
tivity from  defect  of  stimulus. 

2.  A second  source  of  animal  inactivity  exists,  when  the  sen- 
sorial power  in  any  part  of  the  system  has  been  previously  ex- 
hausted by  violent  stimuli;  as  the  eyes  after  long  exposure  to 
great  light;  or  the  stomach,  to  repeated  spirituous  potation;  this 
may  be  termed  inactivity  from  exhaustion  of  sensorial  power.  See 
Sect.  XII.  2.  1. 

3.  But  there  is  a third  source  of  inactivity  owing  to  the  defi- 
cient production  of  sensorial  power  in  the  brain;  and  hence 
stimuli  stronger  than  natural  are  required  to  produce  the  accus- 
tomed motions  of  the  arterial  system;  in  this  case  there  is  no 
accumulation  of  sensorial  power  produced;  as  in  the  inactivity 
owing  to  defect  of  stimulus;  nor  any  previous  exhaustion  of  it, 
as  in  the  inactivity  owing  to  excess  of  stimulus. 

This  third  kind  of  inactivity  causes  many  of  the  diseases  of 
this  genus;  which  are  therefore  in  general  to  be  remedied  by 


52 


DISEASES 


CtAss  I.  2.  1. 1 


such  medicines  as  promote  a greater  production  of  sensorial  power 
in  the  brain;  as  the  incitantia,  consisting  of  rvine,  beer  and 
opium,  in  small  repeated  quantities;  and  secondly,  of  such  as 
simply  stimulate  the  arterial  and  glandular  system  into  their  natu- 
ral actions;  as  small  repeated  blisters,  spices  and  essential  oils. 
And  lastly,  the  sorbentia,  which  contribute  to  supply  the  more 
permanent  strength  of  the  system,  by  promoting  the  absorption 
of  nourishment  from  the  stomach  and  intestines;  and  of  the  su- 
perfluous fluid,  which  attends  the  secretions. 

SPECIES. 

1.  Febris  inirritativa.  Inirritative  fever.  This  is  the  typhus 
mitior,  or  nervous  fever  of  some  writers;  it  is  attended  with 
weak  pulse  without  inflammation,  or  symptoms  of  putridity,  as 
they  have  been  called.  When  the  production  of  sensorial  power 
in  the  brain  is  less  than  usual,  the  pulse  becomes  quick  as  well 
as  weak;  and  the  heart  sometimes  trembles  like  the  limbs  of  old 
age,  or  of  enfeebled  drunkards;  and  when  this  force  of  the  con- 
tractions of  the  heart  and  arteries  is  diminished,  the  blood  is 
pushed  on  with  less  energy,  as  well  as  in  less  quantity,  and  thence 
its  stimulus  on  their  sides  is  diminished  in  a duplicate  ratio.  In 
compressions  of  the  brain,  as  in  apoplexy,  the  pulse  becomes 
slower  and  fuller;  for  in  that  disease,  as  in  natural  sleep,  the 
irritative  motions  of  the  heart  and  arteries  are  not  diminished, 
volition  alone  is  suspended  or  destroyed. 

If  the  absorption  of  the  terminations  of  the  veins  is  not  equally 
impaired  with  the  force  of  the  heart  and  arteries,  the  blood  is 
taken  up  by  the  veins  the  instant  it  arrives  at  their  extremities; 
the  capillary  vessels  are  left  empty,  and  there  is  less  resistance  to 
the  current  of  the  blood  from  the  arteries;  hence  the  pulse  be- 
comes empty,  as  well  as  weak  and  quick;  the  veins  of  the  skin 
are  fuller  than  the  arteries  of  it;  and  its  appearance  becomes 
pale,  bluish,  and  shrunk.  See  Class  II.  1.3.  1. 

When  this  pulse  persists  many  hours,  it  constitutes  the  febris 
inirritativa,  or  typhus,  or  nervous  fever,  of  some  writers;  it  is 
attended  with  little  heat,  the  urine  is  generally  of  a natural  colour, 
though  in  less  quantity;  with  great  prostration  of  strength,  and 
much  disturbance  of  the  faculties  of  the  mind.  Its  immediate 
cause  seems  to  be  a deficient  secretion  of  the  sensorial  power 
from  the  inaction  of  the  brain;  hence  almost  the  whole  of  the 
sensorial  power  is  expended  in  the  performance  of  the  motions 
necessary  to  life,  and  little  of  it  can  be  spared  for  the  voluntary 
actions  of  the  locomotive  muscles,  or  organs  of  sense,  see 
Class  I.  2.  5.  3.  Its  more  remote  cause  may  be  from  a paralv- 


Ci-ass  i.  2 1.2, 


OF  IRRITATION. 


53 


sis  or  death  of  some  other  part  of  the  body;  as  of  the  spleen, 
when  a tumour  is  felt  on  the  left  side,  as  in  some  intermittents; 
or  of  the  kidneys,  when  the  urine  continues  pale  and  in  small 
quantity.  Does  the  revivescence  of  these  affected  parts,  or  their 
torpor,  recurring  at  intervals,  form  the  paroxysms  of  these  fe- 
vers? and  their  permanent  revivescence  establish  the  cure?  See 
Class  IV.  2.  1.  19. 

The  inirritative  fever  differs  from  the  puerperal  and  from  the 
hectic  fever,  by  the  permanent  inactivity  of  the  stomach,  which 
in  this  disease  admits  of  no  solid  nutriment.  See  Class  II.  1.  6, 
16.  and  Suppl.  I.  12. 

M.  M.  Wine  and  opium  in  small  quantities  repeated  every 
three  hours  alternately;  small  repeated  blisters;  warm  but  fresh 
air;  sorbentia;  nutrientia;  transfusion  of  blood.  Small  electric 
shocks  passed  through  the  brain  in  all  directions.  Oxygene  air? 

2.  Paresis  inirritativa.  Inirritative  debility.  A defective  ac- 
tion of  the  irritative  motions  without  increase  of  the  frequency 
of  the  pulse.  It  continues  three  or  four  weeks  like  a fever,  and 
then  either  terminates  in  health,  or  the  patient  sinks  into  one 
kind  of  apoplexy,  and  perishes.  Many  symptoms,  which  attend 
inirritative  fevers,  accompany  this  disease,  as  cold  hands  and 
feet  at  periodic  times,  scurf  on  the  tongue,  want  of  appetite, 
muddy  urine,  with  pains  of  the  head,  and  sometimes  vertigo, 
and  vomiting. 

This  disease  differs  from  the  inirritative  fever  by  the  pulse 
not  being  more  frequent  than  in  health.  The  want  of  appetite 
and  of  digestion  is  a principal  symptom,  and  probably  is  the 
cause  of  the  universal  debility,  which  may  be  occasioned  by  the 
want  of  nourishment.  The  vertigo  is  a symptom  of  inirritabili- 
ty, as  shewn  in  Class  IV.  1.  2.  6.  the  muddy  urine  is  owing  to 
increased  absorption  from  the  bladder  in  consequence  of  the  di- 
minished cutaneous  and  cellular  absorption,  as  in  anasarca,  ex- 
plained in  Sect.  XXIX.  5.  1.  and  is  therefore  a consequence  of 
the  inirritability  of  that  part  of  the  system;  the  foul  tongue  is 
owing  to  an  increased  absorption  of  the  thinner  part  of  the  mu- 
cus in  consequence  of  the  general  deficiency  of  fluid,  which 
should  be  absorbed  by  the  skin  and  stomach.  The  sickness  is 
owing  to  decreased  action  of  the  stomach,  which  is  probably 
the  primary  disease,  and  is  connected  with  the  vertigo. 

M.  M.  An  emetic.  Calomel,  grains  iv.  once  or  twice.  Then 
a blister.  Peruvian  bark.  Valerian.  Columbo.  Steel.  Opi- 
um and  wine  in  small  quantities,  repeated  alternately  every  three 
hours.  Small  electric  percussions  through  the  stomach. 

3.  Somnus  interruptus.  Interrupted  sleep.  In  some  fevers, 
where  the  inirritability  is  very  great,  when  the  patient  falls  asleep. 


54 


DISEASES 


Class  I.  2.  1.  4, 


the  pulse  in  a few  minutes  becomes  irregular,  and  the  patient 
awakes  in  great  disorder,  and  fear  of  dy  ing,  refusing  to  sleep  again 
from  the  terror  of  this  uneasy  sensation.  In  this  extreme  debili- 
ty there  is  reason  to  believe,  that  some  voluntary  power  during 
our  waking  hours  is  employed  to  aid  the  irritative  stimuli  in 
carrying  on  the  circulation  of  the  blood  through  the  lungs;  in 
the  same  manner  as  we  use  voluntary  exertions,  when  we  listen 
to  weak  sounds,  or  wish  to  view  an  object  by  a small  light;  in 
sleep  volition  is  suspended,  and  the  deficient  irritation  alone  is 
not  sufficient  to  carry  on  the  pulmonary  circulation.  This  ex- 
planation seems  the  most  probable  one,  because  in  cases  of  apo- 
plexy the  irritative  motions  of  the  arterial  system  do  not  seem  to 
be  impaired,  nor  in  common  sleep.  See  Incubus  III.  2.  1.  13. 

M.  M.  Opium  in  very  small  doses,  as  three  drops  of  lauda- 
num. A person  should  watch  the  patient,  and  awaken  him  fre- 
quently; or  he  should  measure  the  time  between  slumber  and 
slumber  by  a stop-watch,  and  awaken  the  patient  a little  before  he 
would  otherwise  awake;  or  he  should  keep  his  finger  on  the 
pulse,  and  should  forcibly  awaken  him,  as  soon  as  it  becomes  ir- 
regular, before  the  disorder  of  the  circulation  becomes  so  great 
as  to  disturb  him.  See  Class  I.  2.  1.  9.  and  Sect.  XXVII.  2. 

4.  Syncope.  Fainting  consists  in  the  decreased  action  of  the 
arterial  system;  which  is  sometimes  occasioned  by  defect  of  the 
stimulus  of  distention,  as  after  venesection,  or  tapping  for  the 
dropsy.  At  other  times  it  arises  from  great  emotions  of  the 
mind,  as  in  sudden  joy  or  grief.  In  these  cases  the  whole  senso- 
rial power  is  exerted  on  these  interesting  ideas,  and  becomes  ex- 
hausted. Thus  during  great  surprise  or  fear  the  heart  stops  for 
a time,  and  then  proceeds  with  throbbing  and  agitation;  and 
sometimes  the  vital  motions  become  so  deranged,  as  never  to  re- 
cover their  natural  successive  action;  as  when  children  have 
been  frightened  into  convulsions.  See  Sect.  XII.  7.  1. 

Miss , a young  lady  of  Stafford,  in  travelling  in  a chaise, 

was  so  affected  by  seeing  the  fall  of  a horse  and  postillion,  in  go- 
ing down  a hill,  though  the  carriage  was  not  overturned,  that 
she  fainted  away,  and  then  became  convulsed,  and  never  spoke 
afterwards;  though  she  lived  about  three  days  in  successive  con- 
vulsions and  stupor. 

5.  Hcernorrhagia  venosa.  A bleeding  from  the  capillaries  aris- 
ing from  defect  of  venous  absorption,  as  in  some  of  those  fevers 
commonly  termed  putrid.  When  the  blood  stagnates  in  the  cel- 
lular membrane,  it  produces  pctechiae  from  this  torpor  or  paraly- 
sis of  the  absorbent  mouths  of  the  veins.  It  must  be  observed, 
that  those  people  who  have  diseased  livers,  are  more  liable  to  this 
kind  of  hcemorrhages,  as  well  as  to  the  haemorrkagia  artcriosa; 


Class!.  2. 1.  6. 


OP  IRRITATION. 


55 


the  former,  because  patients  with  diseased  livers  are  more  sub- 
ject to  paralytic  complaints  in  general,  as  to  hemiphlegia,  and  to 
dropsy,  which  is  a paralysis  of  the  lymphatics;  and  the  latter  is 
probably  owing  to  the  delay  of  the  circulation  in  the  vena  por- 
ta by  the  torpor  of  this  hepatic  vessel,  when  the  liver  is  not 
much  enlarged;  and  to  its  pressure  on  the  vena  cava,  when  it  is 
much  enlarged. 

I have  seen  two  elderly  men,  and  one  middle  aged  woman,  all 
of  whom  had  drunk  too  much  fermented  or  spirituous  liquors, 
and  had  been  for  some  months  gradually  sinking,  were  seized 
with  a ceaseless  haemorrhage  from  their  mouths,  and  from  every 
part  of  the  skin,  where  they  happened  to  scratch  themselves, 
which  continued  some  days  till  they  died.  See  Sect.  XXVII.  2. 

M.  M.  Vitriolic  acid,  opium,  steel,  bark.  Sponge  bound  on 
the  part.  Steel  dissolved  in  spirit  of  wine  externally.  Flour. 

6.  Ho&morrhois  cruenta.  In  the  bleeding  piles  the  capillary 
vessels  of  the  rectum  become  distended  and  painful  from  the  de- 
fect of  the  venous  absorption  of  the  part,  and  at  length  burst;  or 
the  mucous  glands  are  so  dilated  as  to  give  a passage  to  the 
blood;  it  is  said  to  observe  lunar  periods. 

M.  M.  Venesection,  poultices,  cathartics,  spice,  cold  bath, 
and  sorbentia.  External  compression  by  applying  lint,  sponge, 
or  cotton.  Internal  compression  by  applying  a bit  of  candle 
smeared  with  mercurial  ointment.  Strangulate  the  tumid  piles 
with  a silk  string.  Cut  them  off.  See  Sect.  XXVII.  2. 

Mrs. had  for  twelve  or  fifteen  years,  at  intervals  of  a 

year  or  less,  a bleeding  from  the  rectum  without  pain;  which 
however  stopped  spontaneously  after  she  became  weakened,  or 
by  the  use  of  injections  of  brandy  and  water.  Lately  the  bleed- 
ing continued  above  two  months,  in  the  quantity  of  many  ounces 
a day,  till  she  became  pale  and  feeble  to  an  alarming  degree. 
Injections  of  solutions  of  lead,  of  bark  and  salt  of  steel,  and  of 
turpentine,  with  some  internal  astringents,  and  opiates,  were  used 
in  vain.  An  injection  of  the  smoke  of  tobacco,  with  ten  grains 
of  opium  mixed  with  the  tobacco,  was  used,  but  without  effect 
the  two  first  times  on  account  of  the  imperfection  of  the  machine; 
on  the  third  time  it  produced  great  sickness  and  vertigo,  and  near- 
ly a fainting  fit;  from  which  time  the  blood  entirely  stopped. 
Was  this  owing  to  a fungous  excrescence  in  the  rectum;  or  to  a 
blood-vessel  being  burst  from  the  difficulty  of  the  blood  passing 
through  the  vena  porta  from  some  hepatic  obstruction,  and  which 
had  continued  to  bleed  so, .long?  Was  it  stopped  at  last  by  the 
fainting  fit?  or  by  the  stimulus  of  the  tobacco? 

7.  Hcemorrhagia  renum.  Ilasmorrhage  from  the  kidneys, 
when  attended  with  no  pain,  is  owing  to  defect  of  venous  absorp- 


56 


DISEASES 


Class  I.  2.  1.  8. 


tion  in  the  kidney.  When  attended  with  pain  on  motion,  it  is 
owing  to  a bit  of  gravel  in  the  ureter  or  pelvis  of  the  kidney; 
which  is  a much  more  frequent  disease  than  the  former.  See 
Sect.  XXVII.  1. 

M.  M.  1.  Venesection  in  small  quantity,  calomel,  bark,  steel, 
an  opiate;  cold  immersion  up  to  the  navel,  the  upper  part  of  the 
body  being  kept  clothed.  Neville-Holt  water.  2.  Alcalized 
water  aerated.  Much  diluent  liquids.  Cool  dress.  Cool  bed- 
room. 

Cows  are  much  subject  to  bloody  urine,  called  foul  water  by 
the  farmers;  in  this  disease  about  sixty  grains  of  opium  with  or 
without  as  much  rust  of  iron,  given  twice  a day,  in  a ball  mixed 
with  flour  and  water,  or  dissolved  in  warm  water,  or  warm  ale, 
are,  I believe,  an  efficacious  remedy,  to  which  however  should 
be  added  about  two  quarts  of  barley  or  oats  twice  a day,  and  a 
cover  at  night,  if  the  weather  be  cold. 

8.  Hamorrhagia  hepatis.  Haemorrhage  from  the  liver.  It 
sometimes  happens  in  those,  who  have  the  gutta  rosea,  or  para- 
lytic affections  owing  to  diseased  livers  induced  by  the  potation 
of  fermented  liquors,  that  a great  discharge  of  black  viscid  blood 
occasionally  comes  aw7ay  by  stool,  and  sometimes  by  vomiting: 
this  the  ancients  called  melancholia,  black  bile.  If  it  w as  bile, 
a small  quantity  of  it  would  become  yellow7  or  green  on  dilution 
with  warm  water,  which  was  not  the  case  in  one  experiment 
which  I tried;  it  must  remain  some  time  in  the  intestines  from 
its  black  colour,  when  it  passes  dowmwards,  and  probably  comes 
from  the  bile-ducts,  and  is  often  a fatal  symptom.  When  it  is 
evacuated  by  vomiting  it  is  less  dangerous,  because  it  shews 
greater  remaining  irritability  of  the  intestinal  canal,  and  is  some- 
times salutary  to  those  who  have  diseased  livers. 

Tw'O  elderly  men,  who  had  lost  their  appetite  for  animal  food, 
which  is  always  a dangerous  symptom,  when  it  occurs  to  those 
who  have  drunk  too  much  fermented  liquor,  observed,  that  they 
parted  with  black  stools.  One  of  them  also  had  the  mucus  of 
his  nostrils  occasionally  stained  with  blood.  The  black  stools 
appeared  evidently  to  consist  of  the  coagulum  of  blood,  some- 
times without  other  feces.  After  a few  weeks  they  both  sunk 
under  this  discharge,  which  I supposed  to  proceed  from  the  li- 
ver, as  it  never  appeared  florid  in  any  part  of  it.  See  Section 
XXVII.  2. 

M.  M.  An  emetic.  Rhubarb,  steel,  wine,  bark,  opium. 

9.  Hczrnoptoe  venosa.  Venous  has  mop  toe  frequently  attends 
the  beginning  of  the  hereditary  consumptions  of  dark-eyed  peo- 
ple; and  in  others,  wdiose  lungs  have  too  little  irritability.  These 
spittings  of  blood  are  generally  in  very  small  quantity,  as  a tea- 


Class  I.  2.  1. 10. 


OF  IRRITATION. 


57 


spoonful;  and  return  at  first  periodically,  as  about  once  a 
month;  and  are  less  dangerous  in  the  female  than  in  the  male 
sex;  as  in  the  former  they  are  often  relieved  by  the  natural  pe- 
riods of  the  menses.  Many  of  these  patients  are  attacked  with 
this  pulmonary  haemorrhage  in  their  first  sleep;  because  in  fee- 
ble people  the  power  of  volition  is  necessary,  besides  that  of  irri- 
tation, to  carry  on  respiration  perfectly;  but,  as  volition  is  sus- 
pended during  sleep,  a part  of  the  blood  is  delayed  in  the  ves- 
sels of  the  lungs,  and  in  consequence  effused,  and  the  patient 
awakes  from  the  disagreeable  sensation.  See  Class  I.  2.  1.  3. 
II.  1.6.  6.  III.  2.  1.  10.  and  Sect.  XXVII.  2. 

M M.  Wake  the  patient  every  two  or  three  hours  by  an 
alarum  clock.  Give  half  a grain  of  opium  at  going  to  bed,  or 
twice  a day.  Onions,  garlic,  slight  chalybeates.  Issues.  Leeches 
applied  once  a fortnight  or  month  to  the  haemorrhoidal  veins  to 
produce  a new  habit.  Emetics  after  each  period  of  haemoptoe, 
to  promote  expectoration,  and  dislodge  any  effused  blood,  which 
might  by  remaining  in  the  lungs  produce  ulcers  by  its  putridity. 
A hard  bed,  to  prevent  too  sound  sleep.  A periodical  emetic  or 
cathartic  once  a fortnight. 

10.  Palpitatio  cordis.  The  palpitation  of  the  heart  frequently 
attends  the  haemoptoe  above  mentioned;  and  consists  in  an  in- 
effectual exertion  of  the  heart  to  push  forwards  its  contents  in 
due  time,  and  with  due  force.  The  remote  cause  is  frequently 
some  impediment  to  the  general  circulation;  as  the  torpor  of 
the  capillaries  in  cold  paroxysms  of  fever,  or  great  adhesions  of 
the  lungs.  At  other  times  it  arises  from  the  debility  of  the  action 
of  the  heart  owing  to  the  deficient  sensorial  power  of  irritation 
or  of  association,  as  at  the  approach  of  death. 

In  both  these  cases  of  weak  exertion  the  heart  feels  large  to  the 
touch,  as  it  does  not  completely  empty  itself  at  each  contraction; 
and  on  that  account  contracts  more  frequently,  as  described  in 
Sect.  XXXII.  2.  2.  Another  kind  of  palpitation  may  sometimes 
arise  from  the  retrograde  motions  of  the  heart,  as  in  fear.  See 
Class  I.  3.  1.2.  and  IV.  3.  1.  6. 

1 1.  Menorrhagia.  Continued  flow  of  the  catamenia.  The 
monthly  effusion  of  blood  from  the  uterus  or  vagina  is  owing  to 
a torpor  of  the  veins  of  those  membranes  in  consequence  of  the 
defect  of  venereal  stimulus;  and  in  this  respect  resembles  the 
mucus  discharged  in  the  periodical  venereal  orgasm  of  the  female 
quadrupeds,  which  are  secluded  from  the  males.  The  menorr-  * 
hagia,  or  continued  flow  of  this  discharge,  is  owing  to  a con- 
tinued defect  of  the  venous  absorption  of  the  membranes  of  the 
uterus  or  vagina.  See  Class  IV.  2.  4.  7. 

M.  M.  Venesection  in  small  quantity.  A cathartic.  Then 

VOL.  II.  I 


58 


DISEASES 


Class  I.  2.  1. 12. 


opium,  a grain  every  night.  Steel.  Bark.  A blister.  Topi- 
cal aspersion  with  cold  water,  or  cold  vinegar. 

One  cause  of  excessive  menstruation,  which  sometimes  recurs 
monthly,  and  continues  for  a fortnight  at.  each  period,  and  is 
succeeded  by  fluor  albus  during  the  intervals,  I have  suspected  to 
arise,  like  the  bleeding  piles,  from  enlargement  of  the  liver,  which 
is  liable  to  occur  about  the  age  of  forty  to  those  who  have  drunk 
much  strong  small  beer,  or  wine;  or  to  those  who  have  unfor- 
tunately been  long  accustomed  to  the  use  of  tight  stays,  or  other 
bandages  round  their  bowels.  In  these  situations  6 or  8 grains  of 
rhubarb  should  be  taken  every  night  for  months,  or  even  years. 
Calomel, 4 or  6 grains  should  be  taken  as  a cathartic  once  a month. 
A flannel  dress  on  the  legs,  thighs,  and  lower  body  may  be  use- 
ful in  the  cold  season,  but  injurious  in  the  warmer  months. 
Weak  acid  of  vitriol  ten  drops,  two  or  three  times  a day;  steel 
in  very  small  quantity;  and  a very  loose  dress  round  the  body; 
are  recommended. 

12.  Dysmenorrhagia.  A difficulty  of  menstruation  attended 
with  pain.  In  this  complaint  the  torpor  of  the  uterine  vessels, 
which  precedes  menstruation,  is  by  sympathy  accompanied  with 
a torpor  of  the  lumbar  membranes,  and  consequent  pain;  and 
frequently  with  cold  extremities,  and  general  debility.  The 
small  quantity  and  difficulty  of  the  discharge  is  owing  to  arterial 
inactivity,  as  in  chlorosis.  Whence  it  happens,  that  chalybeate 
medicines  are  of  efficacy  both  to  stop  or  prevent  too  great  men- 
struation, and  to  promote  and  increase  deficient  menstruation; 
as  the  former  is  owing  to  irritability  of  the  veins,  and  the  lat- 
ter of  the  arteries  of  the  uterus.  See  Article  IV.  2.  6.  in  the 
Materia  Medica. 

M.  M.  Opium,  steel,  pediluvium.  Warm  bath. 

13.  Lochia  nimia.  Too  great  discharge  after  delivery.  In  that 
unnatural  practice  of  some  hasty  accoucheurs  of  introducing  the 
hand  into  the  uterus  immediately  after  the  delivery  of  the  child, 
and  forcibly  bringing  away  the  placenta,  it  frequently  happens, 
that  a part  of  it  is  left  behind;  and  the  uterus,  not  having  power 
to  exclude  so  small  a portion  of  it,  is  prevented  from  com- 
plete contraction,  and  a great  hasmorrhage  ensues.  In  this  cir- 
cumstance a bandage  with  a thick  compress  on  the  lower  part  of 
the  belly,  by  appressing  the  sides  of  the  uterus  on  the  remaining 
part  of  the  placenta,  is  likely  to  check  the  haemorrhage,  like  the 
application  of  a pledget  of  any  soft  substance  on  a bleeding  vessel. 

In  other  cases  the  lochia  continues  too  long,  or  in  too  great 
quantity,  owing  to  the  deficiency  of  venous  absorption. 

M.  M.  An  enema.  An  opiate.  A blister.  Slight  chalybe- 
ates.  Peruvian  bark.  Cloths  dipped  in  cold  vinegar  and  applied 


OF  IRRITATION.’ 


Ciass  I.  2. 1.  14. 


59 


externally.  Bandages  on  the  limbs  to  keep  more  blood  in  them 
for  a time  have  been  recommended. 

14.  Jlbortio  Spontanea.  Some  delicate  ladies  are  perpetually 
liable  to  spontaneous  abortion,  before  the  third  or  after  the 
seventh  month  of  gestation.  From  some  of  these  patients  I have 
learnt,  that  they  have  awakened  with  a slight  degree  of  difficult 
respiration,  so  as  to  induce  them  to  rise  hastily  up  in  bed;  and 
have  hence  suspected,  that  this  was  a tendency  to  a kind  of  asth- 
ma, owing  to  a deficient  absorption  of  blood  in  the  extremities 
of  the  pulmonary  or  bronchial  veins;  and  have  concluded  from 
thence,  that  there  was  generally  a deficiency  of  venous  absorp- 
tion; and  that  this  was  the  occasion  of  their  frequent  abortion. 
Which  is  further  countenanced,  where  a great  sanguinary  dis- 
charge precedes  or  follows  the  exclusion  of  the  fetus. 

Miscarriages  are  sometimes  induced  by  what  is  termed  a re- 
troversion of  the  uterus,  in  which  the  fundus  uteri  is  retroverted 
and  pressed  down  between  the  rectum  and  the  vagina.  This 
can  only  occur  in  the  first  or  second  month  of  gestation,  and  is 
generally  preceded  by  a difficulty  of  making  water,  and  a conse- 
quent tumour  of  the  bladder;  a violent  pain  about  the  perinmum 
or  rectum  is  thus  caused,  and  a miscarriage  is  liable  to  follow. 
Drawoff  the  urine  with  the  catheter;  inject  an  enema  with  sixty 
drops  of  tincture  of  opium,  if  it  can  be  done.  If  it  recurs  fre- 
quently after  the  miscarriage,  a wax  candle,  or  a pessary,  made 
by  rolling  some  emplastrum  de  minio  spread  on  linen,  may  be 
introduced  into  the  rectum,  and  worn  as  a compress  to  pre- 
vent the  return  for  a few  days,  till  the  parts  recover  their 
strength.  See  London  Medical  Observations,  Vol.  IV.  p.  388. 
and  Dr.  Hunter’s  Tables  of  the  Gravid  Uterus. 

M.  M.  Opium,  bark,  cbalybeates  in  small  quantity.  Change 
to  a warmer  climate.  I have  directed  with  success  in  four  cases 
half  a grain  of  opium  twice  a day  for  a fortnight,  and  then  a 
whole  grain  twice  a day  during  the  whole  gestation.  One  of 
these  patients  took  besides  twenty  grains  of  Peruvian  bark  for 
several  weeks.  By  these  means  being  exactly  and  regularly  per- 
sisted in,  a new  habit  became  established,  and  the  usual  miscar- 
riages were  prevented. 

Miscarriages  more  frequently  happen  from  eruptive  fevers,  and 
from  rheumatic  ones,  than  from  other  inflammatory  diseases.  I 
saw  a most  violent  pleurisy  and  hepatitis,  cured  by  repeated  vene- 
section about  a week  or  ten  days  before  parturition;  yet  another 
lady  whom  I attended,  miscarried  at  the  end  of  the  chicken-pox, 
with  which  her  children  were  at  the  same  time  affected.  Miscar- 
riages towards  the  termination  of  the  small-pox  are  very  frequent, 
yet  there  have  been  a few  instances  of  children,  who  have  been 


60 


DISEASES 


Class  I.  2. 1.  15. 


born  with  the  eruption  on  them.  The  blood  in  the  small-pox  will 
not  inoculate  that  disease,  if  taken  before  the  commencement  of 
the  secondary  fever;  as  shewn  in  Sect.  XXXIII.  2.  10.  because 
the  contagious  matter  is  not  yet  formed,  but  after  it  has  been 
oxygenated  through  the  cuticle  in  the  pustules,  it  becomes  con- 
tagious; and  if  it  be  then  absorbed,  as  in  the  secondary  fever, 
the  blood  of  the  mother  may  become  contagious,  and  infect  the 
child.  The  same  mode  of  reasoning  is  applicable  to  the  chicken- 
pox.  See  Class  IV.  3.  1.  7. 

15.  Scorbutus.  Sea-scurvy  is  caused  by  salt  diet,  the  perpe- 
tual stimulus  of  which  debilitates  the  venous  and  absorbent  sys- 
tems; and  may  also  be  promoted  by  the  sea-air,  which  is  known 
to  be  so  injurious  to  most  vegetables,  which  grow  near  the  coasts, 
and  has  been  perhaps  incautiously  recommended  to  consumptive 
patients.  See  Class  II.  1.  6.  7.  Hence  the  blood  is  imperfect- 
ly taken  up  by  the  veins  from  the  capillaries,  whence  browTn 
and  black  spots  appear  upon  the  skin  without  fever.  The  limbs 
become  livid  and  edematous,  and  lastly  ulcers  are  produced  from 
deficient  absorption.  See  Sect.  XXXIII.  3.  2.  and  Class  II.  1. 
4.  13.  For  an  account  of  the  scurvy  of  the  lungs,  see  Sect. 
XXVII.  2. 

M.  M.  Fresh  animal  and  vegetable  food.  Infusion  of  malt. 
New  beer.  Sugar.  Wine.  Steel.  Bark.  Sorbentia.  Opium? 

16.  Vibices.  Extravasations  of  blood  become  black  from  their 
being  secluded  from  the  air.  The  extravasation  of  blood  in 
bruises,  or  in  some  fevers,  or  after  death  in  some  patients, 
especially  in  the  parts  which  were  exposed  to  pressure,  is  owing 
to  the  fine  terminations  of  the  veins  having  been  mechanically 
compressed  so  as  to  prevent  their  absorbing  the  blood  from  the 
capillaries,  or  to  their  inactivity  from  disease.  The  blood  when 
cxtravasated  undergoes  a chemical  change  before  it  is  sufficient- 
ly fluid  to  be  taken  up  by  the  lymphatic  absorbents,  and  in  that 
process  changes  its  colour  to  green  and  then  yellowr. 

17.  Petechiw.  Purple  spots.  These  attend  fevers  with  great 
venous  inirritability,  and  are  probably  formed  by  the  inability 
of  a single  termination  of  a vein,  whence  the  corresponding 
capillary  becomes  ruptured,  and  effuses  the  blood  into  the  cellu- 
lar membrane  round  the  inert  termination  of  the  vein.  This  is 
generally  esteemed  a sign  of  the  putrid  state  of  the  blood,  or  that 
state  contrary  to  the  inflammatory  one.  As  it  attends  some  in- 
flammatory diseases  which  are  attended  with  great  inirritability, 
as  in  the  confluent  small-pox.  But  it  also  attends  the  scurvy, 
where  no  fever  exists,  and  it  therefore  simply  announces  the  in- 
activity of  the  terminations  of  some  veins;  and  is  thence  indeed 
a bad  symptom  in  fevers,  as  a mark  of  approaching  inactivity  of 


Ciass  I.  2.1.18. 


OF  IRRITATION. 


61 


the  whole  sanguiferous  system,  or  death.  The  blue  colour  of 
some  children’s  arms  or  faces  in  very  cold  weather  is  owing  in 
like  manner  to  the  torpor  of  the  absorbent  terminations  of  the 
veins  whence  the  blood  is  accumulated  in  them,  and  sometimes 
bursts  them.  See  Hasmorrhagia  venosa,  and  Suppl.  1.  2.  7. 

In  some  cases  of  fever  attended  with  peteehiae,  Dr.  Hall,  of 
Colchester,  directed  the  body  to  be  washed  with  cold  vinegar 
and  water  twice  a day,  with  great  advantage.  The  peteehiae  be- 
came daily  less  numerous  and  less  livid,  the  pulse  slower  and 
stronger,  with  less  delirium,  and  more  sleep.  He  has  treated 
twenty  cases  in  this  manner,  and  not  lost  one.  Medical  Re- 
view, Vol.  III.  p.  8. 

In  these  cases  not  only  the  application  of  external  cold  seems 
to  have  been  of  service,  by  preventing  the  unnecessary  expendi- 
ture of  animal  power;  but  as  the  stimulus  of  vinegar  renders 
the  lips  pale,  when  applied  externally,  and  in  consequence  stimu- 
lates the  terminations  of  the  veins  into  greater  action;  it  seems 
also  to  have  contributed  to  remove  the  peteehiae. 

18.  Jlneurismci.  Aneurism  is  probably  owing  to  the  wTant  of 
due  irritability  of  a part  of  the  coat  of  an  artery.  As  living 
muscles  are  known  to  resist  diruption  more  than  dead  ones,  ac- 
cording to  the  experiments  (I  think)  of  Dr.  Langrish,  it  follows 
that  when  a part  of  the  coat  of  an  artery  ceases  to  contract  by 
the  stimulus  of  the  blood,  that  it  will  soon  become  distended  by 
the  force  of  it,  till  it  widens  into  a sack,  and  at  last  becomes 
ruptured. 

M.  M.  Venesection  repeatedly  in  small  quantities.  Rest. 
Diluent,  mild  nutriment.  Daily  evacuation  by  a pill  consisting 
of  rhubarb  eight  grains,  and  soap  four  grains. 

It  is  possible  also,  that  an  aneurism  may  be  produced  by  the 
resistance  to  the  circulation,  and  the  force  of  the  heart  being 
greater  than  the  sides  of  the  arteries  can  counterbalance. 

Mr.  Gimbernat  is  said  to  have  cured  some  cases  of  aneurism 
in  the  popliteal  artery  by  compressing  it  by  means  of  an  adapted 
machine,  consisting  of  a steel  ring  above  and  below  the  knee, 
which  are  joined  by  a plate,  beneath  which  is  placed  a proper 
cushion,  which  can  be  pressed  on  the  distended  part  of  the  artery 
more  or  less  by  means  of  a screw.  The  other  method  of  cure 
is  by  a double  ligature  above  the  aneurism,  as  first  practised  by 
Mr.  J.  Hunter. 

19.  Varix.  The  varix  of  veins  occurs  frequently  in  the  legs 
of  women,  possibly  sometimes  from  tight  garters,  and  has  for  its 
proximate  cause  the  inirritability  of  the  coat  of  the  vein;  whence 
it  becomes  distended,  till  it  bursts,  by  the  power  with  which  the 


62 


DISEASES 


Class  I.  2.  1.  19. 


blood  is  thrown  into  it  by  the  absorbent  mouths,  which  take  it 
up  from  the  capillary  arteries. 

M.  M.  Tie  the  vena  saphena  below  the  joint  of  the  knee,  and 
the  blood  will  then  circulate  by  the  internal  veins;  and  that 
stopped  in  the  veins  beneath  the  ligature  will  be  absorbed. 

The  piles  may  be  termed  varixes,  and  may  be  destroyed  by 
excision  or  ligature.  See  Haemorrhois. 


Class  I.  2.  2.  1. 


OF  IRRITATION. 


6.3 


ORDO  II. 

Decreased  Irritation. 

GENUS  II. 

Decreased  Action  of  the  Secerning  System. 

These  are  always  attended  with  decrease  of  partial,  or  of 
general  heat;  for  as  the  heat  of  animal  bodies  is  the  consequence 
of  their  various  secretions,  and  is  perpetually  passing  away  into 
the  ambient  air,  or  other  bodies  in  contact  with  them;  when  these 
secretions  become  diminished,  or  cease,  the  heat  of  the  part  or  of 
the  whole  is  soon  diminished,  or  ceases  along  with  them. 

SPECIES. 

1.  Fngus  febrile.  Febrile  coldness.  There  is  reason  to  be- 
lieve, that  the  beginning  of  many  fever-fits  originates  in  the  quies- 
cence of  some  part  of  the  absorbent  system,  especially  where  they 
have  been  owing  to  external  cold;  but  that,  where  the  coldness  of 
the  body  is  not  owing  to  a diminution  of  external  heat,  it  arises 
from  the  inaction  of  some  part  of  the  secerning  system.  Hence 
some  parts  of  the  body  are  hot  whilst  other  parts  are  cold;  which 
I suppose  gave  occasion  to  error  in  Martyn’s  Experiments;  where 
he  says,  that  the  body  is  as  hot  in  the  cold  paroxysms  of  fevers 
as  at  other  times. 

After  the  sensorial  power  has  been  much  diminished  by  great 
preceding  activity  of  the  system,  as  by  long  continued  external 
heat,  or  violent  exercise,  a sudden  exposure  to  much  cold  pro- 
duces a torpor  both  greater  in  degree  and  over  a greater  portion 
of  the  system,  by  subtracting  their  accustomed  stimulus  from 
parts  already  much  deprived  of  their  irritability.  Dr.  Franklin 
in  a letter  to  M.  Duberge,  the  French  translator  of  his  works, 
mentions  an  instance  of  four  young  men,  who  bathed  in  a cold 
spring  after  a day’s  harvest  work;  of  whom  two  died  on  the 
spot,  a third  on  the  next  morning,  and  the  other  survived  with 
difficulty.  Hence  it  would  appear,  that  those,  who  have  to 
travel  in  intensely  cold  weather,  will  sooner  perish,  who  have 
previously  heated  themselves  much  with  drams,  than  those  who 
have  only  the  stimulus  of  natural  food;  of  which  I have  heard 
one  well  attested  instance.  See  Article  VII.  2.  3.  Class  III. 
2.  1.  17. 

Fngus  chronicim.  Permanent  coldness.  Coldness  of  the  ex- 


64 


DISEASES 


Class  I.  2.  2.  2, 


tremities,  without  fever,  with  dry  pale  skin,  is  a symptom  of 
general  debility,  owing  to  the  decreased  action  of  the  arterial  sys- 
tem, and  of  the  capillary  vessels;  whence  the  perspirable  matter 
is  secreted  in  less  quantity,  and  in  consequence  the  skin  is  less 
warm.  This  coldness  is  observable  at  the  extremities  of  the  limbs, 
ears,  and  nose,  more  than  in  any  other  parts:  as  a larger  surface 
is  here  exposed  to  the  contact  of  the  air,  or  clothes,  and  thence 
the  heat  is  more  hastily  carried  away. 

The  pain,  which  accompanies  the  coldness  of  the  skin,  is 
owing  to  the  deficient  exertion  of  the  subcutaneous  vessels,  and 
probably  to  the  accumulation  of  sensorial  power  in  the  extremi- 
ties of  their  nerves.  See  Sect.  XII.  5.  3.  XIY.  6.  XXXII.  3. 
and  Class  I.  2.  4.  1. 

M.  M.  A blister.  Incitantia,  nutrientia,  sorbentia.  Exercise. 
Clothes.  Fire.  Joy.  Anger. 

2.  Pallor  fugitivus.  The  fugitive  paleness,  which  accom- 
panies the  coldness  of  the  extremities,  is  owing  to  a less  quantity 
of  blood  passing  through  the  capillaries  of  the  skin  in  a given 
time;  where  the  absorbent  pou'er  of  the  veins  is  at  the  same 
time  much  diminished,  a part  of  the  blood  lingers  at  their  junction 
with  the  capillary  arteries,  and  a bluish  tinge  is  mixed  with  the 
paleness;  as  is  seen  in  the  loose  skin  under  the  eye-lids,  and  is 
always  a mark  of  temporary  debility.  See  Class  II.  1.  4.  4. 
Where  the  paleness  of  the  skin  is  owing  to  the  deficiency  of  red 
globules  in  the  blood,  it  is  joined  with  a yellowish  tinge;  which 
is  the  colour  of  the  serum,  with  which  the  blood  then  abounds,  as 
in  chlorosis,  and  in  torpor  or  paralysis  of  the  liver,  and  is  often 
mistaken  for  a superabundance  of  bile. 

A permanent  paleness  of  the  skin  is  owing  to  the  coalescence 
of  the  minute  arteries,  as  in  old  age.  See  Class  I.  2.  2.  9. 
There  is  another  source  of  paleness  from  the  increased  absorption 
of  the  termination  of  the  veins,  as  when  vinegar  is  applied  to  the 
lips.  See  Sect.  XXVII.  1.  and  another  from  the  retrograde  mo- 
tions of  the  capillaries  and  fine  extremities  of  the  arteries.  See 
Class  II.  3.  1.  1. 

M.  M.  A blister,  nutrientia,  incitantia,  exercise,  oxygene  gas. 

3.  Pusparcius.  Diminished  pus.  Dryness  of  ulcers.  In  the 
cold  fits  of  fever  all  the  secretions  are  diminished,  whether  natural 
or  artificial,  as  their  quantity  depends  on  the  actions  of  the  glands 
or  capillaries,  which  then  share  in  the  universal  inaction  of  the 
system.  Hence  the  dryness  of  issues  and  blisters  in  great  de- 
bility, and  before  the  approach  of  death,  is  owing  to  deficient  secre- 
tion, and  not  to  increased  absorption. 

M.  M.  Opium,  wine  in  very  small  quantities,  Peruvian  bark. 

4.  Mucus  parcior.  Diminished  mucus.  Dryness  of  the 


Class  I.  2.  2.  5. 


OF  IRRITATION. 


65 


mouth  and  nostrils.  This  also  occurs  in  the  cold  fits  of  intermit- 
ients.  In  these  cases  I have  also  found  the  tongue  cold  to  the 
touch  of  the  finger,  and  the  breath  to  the  back  of  one’s  hand, 
when  opposed  to  it,  which  are  very  inauspicious  symptoms,  and 
generally  fatal.  In  fevers  with  inirritability  it  is  generally 
esteemed  a good  symptom,  when  the  nostrils  and  tongue  become 
moist  after  having  been  previously  dry;  as  it  shews  an  increased 
action  of  the  mucous  glands  of  those  membranes,  which  were  be- 
fore torpid.  And  the  contrary  to  this  is  the  facies  Hippocratica, 
or  countenance  so  well  described  by  Hippocrates,  which  is  pale, 
cold,  and  shrunk;  all  which  are  owing  to  the  inactivity  of  the 
secerning  vessels,  the  paleness  from  there  being  less  red  blood 
passing  through  the  capillaries,  the  coldness  of  the  skin  from 
there  being  less  secretion  of  perspirable  matter,  and  the  shrunk 
appearance  from  there  being  less  mucus  secreted  into  the  cells 
of  the  cellular  membrane.  See  Class  IV.  2.  4.  11. 

M.  M.  Blisters.  Incilantia. 

5.  Urina  parcior  pallida.  Paucity  of  pale  urine,  as  in  the  cold 
fils  of  intermittents;  it  appears  in  some  nervous  fevers  through- 
out the  whole  disease,  and  seems  to  proceed  from  a palsy  of  the 
kidneys;  which  probably  was  the  cause  of  the  fever,  as  the  fever 
sometimes  ceases,  when  that  symptom  is  removed:  hence  the 
straw-coloured  urine  in  this  fever  is  so  far  salutary7,  as  it  shews 
the  unimpaired  action  of  the  kidneys. 

M.  M.  Balsams,  essential  oil,  asparagus,  rhubarb,  a blister. 
Cantharides  internally. 

6.  Torpor  hepaticus.  Paucity  of  bile  from  a partial  inaction 
of  the  liver;  hence  the  bombycinous  colour  of  the  skin,  grey 
stools,  urine  not  yellow,  indigestion,  debility,  followed  by  tym- 
pany, dropsy,  and  death. 

This  paralysis  or  inirritability  of  the  liver  often  destroys  those 
who  have  been  long  habituated  to  much  fermented  liquor,  and 
have  suddenly  omitted  the  use  of  it.  It  also  destroys  plumbers  and 
house-painters,  and  in  them  seems  a substitute  for  the  colica 
saturnina.  See  Sect.  XXX. 

M.  M.  Aloe  and  calomel,  then  the  bark,  and  chalybeates. 
Mercurial  ointment  rubbed  oirthe  region  of  the  liver.  Rhubarb, 
three  or  four  grains,  with  opium  half  a grain  to  a grain  twice  a 
day.  Equitation,  warm  bath  for  half  an  hour  every  day. 

7.  Torpor  pancreatis.  Torpor  of  the  pancreas.  I saw  what 
I conjectured  to  be  a tumour  of  the  pancreas  with  indigestion; 
and  wh:ch  terminated  in  the  death  of  the  patient.  He  had  been 
for  many  years  a great  consumer  of  tobacco,  insomuch  that  he 
chewed  that  noxious  drug  all  the  morning,  and  smoked  it  all  the 
afternoon.  As  the  secretion  from  the  pancreas  resembles  saliva 

VOL.  ir.  k 


DISEASES 


Class  I.  2.  2.  8. 


6t> 

in  its  general  appearance,  and  probably  in  its  office  of  assisting  di- 
gestion, by  preventing  the  fermentation  of  the  aliment;  as  would 
appear  by  the  experiments  of  Pringle  and  Macbride;  there  is 
reason  to  suspect,  that  a sympathy  may  exist  between  the  sali- 
vary and  pancreatic  glands;  and  that  the  perpetual  stimulus  of 
the  former  by  tobacco  might  in  process  of  time  injure  the  latter 
See  Tobacco,  Article  III.  2.  2. 

8.  Torpor  renis.  Inirritability  or  paralysis  of  the  kidneys  is 
probably  frequently  mistaken  for  gravel  in  them.  Several,  who 
have  lived  rather  intemperately  in  respect  to  fermented  or  spi- 
rituous liquors,  become  suddenly  seized  about  the  age  of  sixty,  or 
later,  with  a total  stoppage  of  urine;  though  they  have  previ- 
ously had  no  symptoms  of  gravel.  In  these  cases  there  is  no 
water  in  the  bladder;  as  is  known  by  the  introduction  of  the 
catheter,  of  which  those  made  of  elastic  gum  are  said  to  be  pre- 
ferable to  metallic  ones;  or  it  may  generally  be  known  by  the 
shape  of  the  abdomen,  either  by  the  eye  or  hand.  Bougies  and 
catheters  of  elastic  gum  are  sold  at  No.  37,  Red-Lion  street, 
Holborn,  London. 

M.  M.  Electric  shocks,  warm  bath.  Emetics.  See  calcu- 
lus renis,  Class  I.  1.3.  9.  When  no  gravel  has  been  previously 
observed,  and  the  patient  has  been  a wine-drinker  rather  than 
an  ale-drinker,  the  case  is  generally  owing  to  inirritability  of  the 
tubuli  uriniferi,  and  is  frequently  fatal.  See  Class  I.  2.  4.  20. 

9.  Punctce  mucosa:  vultus.  Mucous  spots  on  the  face.  These 
are  owing  to  the  inactivity  of  the  excretory  ducts  of  the  mucous 
glands;  the  thinner  part  of  this  secretion  exhales,  and  the  remain- 
der becomes  inspissated,  and  lodges  in  the  duct;  the  extremity 
of  which  becomes  black  by  exposure  to  the  air. 

M.  M.  They  may  be  pressed  out  by  the  finger-nails.  Warm 
water.  Ether  frequently  applied.  Blister  on  the  part? 

10.  Macula  cutis  fulvcc.  Morphew  or  freckles.  Tawny 
blotches  on  the  skin  of  the  face  and  arms  of  elderly  people,  and 
frequently  on  their  legs  after  slight  erysipelas.  The  freckles  on 
the  face  of  younger  people,  who  have  red  hair,  seem  to  be  a simi- 
lar production,  and  seem  all  to  be  caused  by  the  coalescence  of 
the  minute  arteries  or  capillaries  of  the  part.  In  a scar  after  a 
wound  the  integument  is  only  opaque;  but  in  these  blotches, 
which  are  called  morphew  and  freckles,  the  small  vessels  seem  to 
have  become  inactive  with  some  of  the  serum  of  the  blood  stag- 
nating in  them,  from  whence  their  colour.  See  Class  III.  1.2.  12. 

M.  M.  Warm  bathing.  A blister  on  the  part? 

11.  Canities.  Grey  hair.  In  the  injection  of  the  vessels  of 
animals^for  the  purposes  of  anatomical  preparations,  the  colour  of 
the  injected  fluid  will  not  pass  into  many  very  minute  vessels' 


Glass  I.  2.  2.  11. 


OF  IRRITATION. 


67 


which  nevertheless  uncoloured  water,  or  spirits,  or  quicksilver, 
will  permeate^  The  same  occurs  in  the  filtration  of  some  co- 
loured fluids  through  paper,  or  very  fine  sand,  where  the  colour- 
ing matter  is  not  perfectly  dissolved,  but  only  diffused  through 
the  liquid.  This  has  led  some  to  imagine,  that  the  cause  of  the 
whiteness  of  the  hair  in  elderly  people  may  arise  from  the  dimi- 
nution, or  greater  tenuity,  of  the  glandular  vessels,  which  secrete 
the  mucus,  which  hardens  into  hair;  and  that  the  same  difference 
of  the  tenuity  of  the  secerning  vessels  may  possibly  make  the 
difference  of  colour  of  the  silk  from  different  silk-worms,  which 
is  of  all  shades  from  yellow  to  white. 

But  as  the  secreted  fluids  are  not  the  consequence  of  mechani- 
cal filtration,  but  of  animal  selection;  we  must  look  out  for 
another  cause,  which  must  be  found  in  the  decreasing  activity  of 
the  glands,  as  we  advance  in  life;  and  which  affects  many  of 
our  other  secretions  as  well  as  that  of  the  mucus,  which  forms 
the  hair.  Hence  grey  hairs  are  produced  on  the  faces  of  horses 
by  whatever  injures  the  glands  at  their  roots,  as  by  corrosive  blis- 
ters; and  frequently  on  the  human  subject  by  external  injuries 
on  the  head;  and  sometimes  by  fevers.  And  as  the  grey  colour 
of  hair  consists  in  its  want  of  transparency,  like  water  converted 
into  snow;  there  is  reason  to  suppose,  that  a defect  of  secreted 
moisture  simply  may  be  the  cause  of  this  kind  of  opacity,  as  ex- 
plained in  Cataracta,  Class  I.  2.  2.  13. 

M.  M.  Whatever  prevents  the  inirritability  and  insensibility 
of  the  system,  that  is,  whatever  prevents  the  approach  of  old  age, 
will  so  far  counteract  the  production  of  grey  hairs,  which  is  a 
symptom  of  it.  For  this  purpose,  in  people,  who  are  not  corpu- 
lent, and  perhaps  in  those  who  are  so,  the  warm  bath  twice  or 
thrice  a week  is  particularly  serviceable.  See  Sect.  XXXIX.  5. 
1.  on  the  colours  of  animals,  and  Class  I.  1.  2.  15. 

As  mechanical  injury  from  a percussion,  or  a wound,  or  a 
caustic,  is  liable  to  occasion  the  hair  of  the  part  to  become  grey; 
so  I suspect  the  compression  of  parts  against  each  other  of  some 
animals  in  the  womb  is  liable  to  render  the  hair  of  those  parts 
of  a lighter  colour;  as  seems  often  to  occur  in  black  cats  and 
dogs.  A small  terrier  bitch  now  stands  by  me,  which  is  black 
on  all  those  parts,  which  were  external,  when  she  was  wrapped 
up  in  the  uterus,  teres  atque  rotunda;  and  those  parts  white, 
which  wrere  most  constantly  pressed  together;  and  those  parts 
tawny,  which  were  generally  but  less  constantly  pressed  to- 
gether. Thus  the  hair  of  the  back  from  the  forehead  to  the  end 
of  the  tail  is  black,  as  well  as  that  of  the  sides,  and  external  parts 
of  the  legs,  both  before  and  behind. 

As  in  the  uterus  the  chin  of  the  whelp  is  bent  down,  and  lies 


68 


DISEASES 


Class  I.  2.  2. 11, 


in  contact  with  the  fore  part  of  the  neck  and  breast;  the  tail  is 
applied  close  against  the  division  of  the  thighs  behind;  the  inside 
of  the  hinder  thighs  are  pressed  close  to  the  sides  of  the  belly. ; all 
these  parts  have  white  hairs. 

The  fore-legs  in  the  uterus  lie  on  each  side  of  the  face;  so 
that  the  feet  cover  part  of  the  temples,  and  compress  the  promi- 
nent part  of  the  upper  eye-brows,  but  are  so  placed  as  to  defend 
the  eye-balls  from  pressure;  it  is  curious  to  observe,  that  the  hah 
of  the  sides  of  the  face,  and  of  the  prominent  upper  eye-brows, 
are  tawny,  and  of  the  inside  of  the  feet  and  legs,  which  covered 
them;  for  as  this  posture  admitted  of  more  change  in  the  latter 
weeks  of  gestation,  the  colour  of  these  parts  is  not  so  far  re- 
moved from  black,  as  of  those  parts,  where  the  contact  or  com- 
pression was  more  uniform. 

I have  lately  also  inspected  a male  cat;  who  is  quite  black  all 
over,  except  those  parts  which  appear  to  have  been  folded  toge- 
ther in  the  uterus;  all  which  are  perfectly  white.  In  both  these 
animals  the  parts  compressed  together  are  so  distinctly  defined 
by  their  colour,  that  the  difference  of  the  curvature  and  situation 
of  them  in  the  uterus  may  be  nicely  discerned:  the  hinder  feet 
of  the  cat  lay  in  the  arm-pits  of  the  fore-legs,  and  are  white; 
her  fore-legs  crossed  over  the  hinder  thighs,  and  left  on  them  a 
white  mark;  but  the  fore-feet,  at  least  the  hind  part  of  them, 
lay  under  the  tail;  whence  the  fore-feet  are  tipped  with  white. 
Where  the  foetus  is  less  tender,  I suppose,  this  compression  in 
the  uterus  does  not  affect  it;  as  dogs  and  cats  are  perpetually 
seen,  which  are  totally  black. 

Where  this  uterine  compression  of  parts  has  not  been  so  great 
as  to  render  the  hair  white  in  other  animals,  it  frequently  hap- 
pens, that  the  extremities  of  the  body  are  white,  as  the  feet, 
and  nose,  and  tips  of  the  ears  of  dogs  and  cats  and  horses,  where 
the  circulation  is  naturally  weaker;  whence  it  would  seem,  that 
the  capillary  glands,  which  form  the  hair,  are  impeded  in  the 
first  instance  by  compression,  and  in  the  last  by  the  debility  of 
the  circulation  in  them.  See  Class  I.  1.  2.  15. 

This  day,  August  8th,  1794,  I have  seen  a negro,  who  was 
born  (as  he  reports)  of  black  parents,  both  father  and  mother,  at 
Kingston  in  Jamaica,  who  has  many  large  white  blotches  on  the 
skin  of  his  limbs  and  body;  which  I thought  felt  not  so  soft  to 
the  finger,  as  the  black  parts.  He  has  a white  divergent  blaze 
from  the  summit  of  his  nose  to  the  vertex  of  his  head;  the  upper 
part  of  which,  where  it  extends  on  the  hairy  scalp,  has  thick 
curled  hair,  like  the  other  part  of  his  head,  but  quite  white.  By 
these  marks  I supposed  him  to  be  the  same  black,  who  is  describ- 
ed, when  only  two  years  old,  in  the  Transactions  of  the  Ameri- 


OF  IRRITATION. 


Ciass  I.  2.  2.  12. 


69 


can  Philosophical  Society,  Vol.  II.  page  292,  where  a female  one 
is  likewise  described  with  nearly  similar  marks. 

The  joining  of  the  frontal  bones,  and  the  bregma,  having  been 
later  than  that  of  the  other  sutures  of  the  cranium,  probably 
gave  cause  to  the  whiteness  of  the  hair  on  these  parts  by  delaying 
or  impeding  its  growth. 

12.  Callus.  The  callous  skin  on  the  hands  and  feet  of  laborious 
people  is  owing  to  the  extreme  vessels  coalescing  from  the  per- 
petual pressure  they  are  exposed  to. 

As  we  advance  in  life,  the  finer  arteries  lose  their  power  of 
action,  and  their  sides  grow  together;  hence  the  paleness  of  the 
skins  of  elderly  people,  and  the  loss  of  that  bloom,  which  is 
owing  to  the  numerous  fine  arteries,  and  the  transparency  of  the 
skin,  that  encloses  them. 

M.  M.  Warm  bath.  Paring  the  thick  skin  with  a knife. 
Smoothing  it  with  a pumice  stone.  Cover  the  part  with  oiled 
silk  to  prevent  the  evaporation  of  the  perspirable  matter,  and 
thus  to  keep  it  moist. 

13.  Cataracta  is  an  opacity  of  the  crystalline  lens  of  the  eye. 
It  is  a disease  of  light-coloured  eyes,  as  the  gulta  serena  is  of 
dark  ones.  On  cutting  off  with  scissors  the  cornea  of  a calf’s 
eye,  and  holding  it  in  the  palm  of  one’s  hand,  so  as  to  gain  a pro- 
per light,  the  artery,  which  supplies  nutriment  to  the  crystalline 
humour,  is  easily  and  beautifully  seen;  as  it  rises  from  the  cen- 
tre of  the  optic  nerve  through  the  vitreous  humour  to  the  crys- 
talline. It  is  this  point,  wdiere  the  artery  enters  the  eye  through 
the  cineritious  part  of  the  optic  nerve,  (which  is  in  part  near  the 
middle  of  the  nerve,)  which  is  without  sensibility  to  light;  as 
is  shewn  by  fixing  three  papers,  each  of  them  about  half  an  inch 
in  diameter,  against  a wall  about  a foot  distant  from  each  other, 
about  the  height  of  the  eye;  and  then  looking  at  the  middle  one, 
with  one  eye,  and  retreating  till  you  lose  sight  of  one  of  the  exter- 
nal papers.  Notwss-the  animal  grows  older,  the  artery  becomes  less 
visible,  and  perhaps  carries  only  a transparent  fluid,  and  at  length 
in  some  subjects  I suppose  ceases  to  be  pervious;  then  it  follows 
that  the  crystalline  lens,  losing  some  fluid,  and  gaining  none,  be- 
comes dry,  and  in  consequence  opaque;  for  the  same  reason, 
that  wet  or  oiled  paper  is  more  transparent  than  when  it  is  dry,  as 
explained  in  Class  1. 1. 4. 1.  The  want  of  moisture  in  the  cornea  of 
old  people,  when  the  exhalation  becomes  greater  than  the  supply, 
is  the  cause  of  its  want  of  transparency;  and  which  like  the  crys- 
talline gains  rather  a ~Hlky  opacity.  The  same  analogy  may  be  used 
to  explain  the  whiteness  of  the  hair  of  old  people,  which  loses 
its  pellucidity  along  with  its  moisture.  See  Class  I.  2.  2.  11. 

M.  M.  Small  electric  shocks  through  the  eye.  A quarter  of 


70 


DISEASES 


Class  I.  2.  2.  lj. 


a grain  of  corrosive  sublimate  of  mercury  dissolved  in  brandy,  or 
taken  in  a pill,  twice  a day  for  six  weeks.  Couching  by  depres- 
sion, or  by  extraction.  The  former  of  these  operations  is  much  to 
be  preferred  to  the  latter,  though  the  latter  is  at  this  time  so 
fashionable,  that  a surgeon  is  almost  compelled  to  use  it,  lest  he 
should  not  be  thought  an  expert  operator.  For  depressing  the 
cataract  is  attended  with  no  pain,  no  danger,  no  confinement, 
and  may  be  as  readily  repeated,  if  the  crystalline  should  rise  again 
to  the  centre  of  the  eye.  The  extraction  of  the  cataract  is  at- 
tended with  considerable  pain,  with  long  confinement,  generally 
with  fever,  always  with  inflammation,  and  frequently  with  irre- 
parable injury  to  the  iris,  and  consequent  danger  to  the  whole 
eye.  Yet  has  this  operation  of  extraction  been  trumpeted  into 
universal  fashion  for  no  other  reason  but  because  it  is  difficult  to 
perform,  and  therefore  keeps  the  business  in  the  hands  of  a few 
empirics,  who  receive  larger  rewards,  regardless  of  the  hazard, 
which  is  encountered  by  the  flattered  patient. 

A friend  of  mine  returned  yesterday  from  London  after  an 
absence  of  many  weeks;  he  had  a cataract  in  a proper  state  for 
the  operation,  and  in  spite  of  my  earnest  exhortation  to  the  con- 
trary, was  prevailed  upon  to  have  it  extracted  rather  than  depress- 
ed. He  was  confined  to  his  bed  three  weeks  after  the  operation, 
and  is  now  returned  with  the  iris  adhering  on  one  side  so  as  to 
make  an  oblong  aperture;  and  which  is  nearly,  if  not  totally, 
without  contraction,  and  thus  greatly  impedes  the  little  vision 
which  he  possesses.  Whereas  I saw  some  patients  couched  by 
depression  many  years  ago  by  a then  celebrated  empiric,  Cheva- 
lier Taylor,  who  were  not  confined  above  a day  or  two,  that  the 
eye  might  gradually  be  accustomed  to  light,  and  who  saw  as 
well  as  by  extraction,  perhaps  better,  without  either  pain,  or 
inflammation,  or  any  hazard  of  losing  the  eye. 

As  the  inflammation  of  the  iris  is  probably  owing  to  forcing 
the  crystalline  through  the  aperture  of  it  in  the  operation  of  ex- 
tracting it,  could  it  not  be  done  more  safely  by  making  the  open- 
ing behind  the  iris  and  ciliary  process  into  the  vitreous  humour? 
but  the  operation  wmuld  still  be  more  painful,  more  dangerous, 
and  not  more  useful  than  that  by  depressing  it. 

If  extraction  of  the  crystalline  be  used,  Dr.  Reimarus  of  Ham- 
burgh advises  to  drop  into  the  eye  previous  to  the  operation, 
some  extract  of  belladonna  dissolved  in  water,  which  he  has  found 
to  produce  a temporary  paralysis  of  the  retina,  and  thence  a 
total  inaction  of  the  iris,  so  that  it  remai>’a,-perfectly  expanded, 
and  is  thence  less  liable  to  be  injured  by  the  operation,  and  the 
eye  perhaps  less  liable  to  inflammation.  Might  not  this  be  of 
advantage  in  some  ophthalmies? 


Class  I.  2.  2. 14. 


OF  IRRITATION. 


71 


14.  Innutritio  ossium.  Innutrition  of  the  bones.  Not  only 
the  blood  effused  in  vibices  and  petechiae,  or  from  bruises,  as 
well  as  the  blood  and  new  vessels  in  inflamed  parts,  are  re-ab- 
sorbed by  the  increased  action  of  the  lymphatics;  but  the  harder 
materials  which  constitute  the  fangs  of  the  first  set  of  teeth,  and 
the  ends  of  exfoliating  bones,  and  sometimes  the  matter  of  chalk- 
stones  in  the  gout,  the  coagulable  lymph,  which  is  deposited  on 
the  lungs,  or  on  the  muscles  after  inflammation  of  those  parts, 
and  which  frequently  produces  difficulty  of  breathing,  and  the 
pains  of  chronic  rheumatism,  and  lastly  the  earthy  part  of  the 
living  bones  are  dissolved  and  absorbed  by  the  increased  actions 
of  this  system  of  vessels.  See  Sect.  XXXIII.  3.  1. 

The  earthy  part  of  bones  in  this  disease  of  the  nutrition  of 
them  seems  to  suffer  a solution,  and  reabsorption;  while  the 
secerning  vessels  do  not  supply  a sufficient  quantity  of  calcareous 
earth  and  phosphoric  acid,  which  constitute  jthe  substance  of 
bones.  As  calcareous  earth  abounds  every  where,  is  the  want  of 
phosphoric  acid  the  remote  cause?  One  cause  of  this  malady  is 
given  in  the  Philosophic  Transactions,  where  the  patient  had 
been  accustomed  to  drink  large  quantities  of  vinegar.  Two  cases 
are  described  by  Mr.  Gouch.  In  one  case,  which  I saw,  a con- 
siderable quantity  of  calcareous  earth,  and  afterwards  of  bone- 
ashes,  and  of  decoction  of  madder,  and  also  of  sublimate  of 
mercury,  were  given  without  effect.  All  the  bones  became  soft, 
many  of  them  broke,  and  the  patient  seemed  to  die  from  the 
want  ofbeing  able  to  distend  her  chest  owing  to  the  softness  of 
the  ribs. 

M.  M.  Salt  of  urine,  called  sal  microcosmicum,  phosphorated 
soda.  Calcined  hartshorn.  Bone-ashes.  Hard  or  petrifying 
water,  as  that  of  Matlock,  or  such  as  is  found  in  all  limestone 
or  marly  countries.  The  calcareous  earth  in  these  waters  might 
possibly  be  carried  to  the  bones,  as  madder  is  known  to  colour 
them.  Warm  bath.  Volatile  or  fixed  alkali  as  a lotion  on  the 
spine,  or  essential  oils. 

The  innutrition  of  the  bones  is  often  first  to  be  perceived  by 
the  difficulty  of  breathing  and  palpitation  of  the  heart  on  walking 
a little  faster  than  usual,  which  I suppose  is  owing  to  the  soft- 
ness of  the  ends  of  the  ribs  adjoining  to  the  sternum;  on  which 
account  they  do  not  perfectly  distend  the  chest,  when  they  are 
raised  by  the  pectoral  and  intercostal  muscles  with  greater  force 
than  usual.  After  this  the  spine  becomes  curved  both  by  the 
softness  of  its  vertebrae,  and  for  the  purpose  of  making  room  for 
the  disturbed  heart.  See  Species  16  of  this  Genus. 

As  these  patients  are  pale  and  weak,  there  would  seem  to  be 
a deficiency  ofoxvgene  in  their  blood,  and  in  consequence  a defi- 


TZ 


DISEASES 


Class  I.  2.  2.  14 


ciency  of  phosphoric  acid;  which  is  probably  produced  by  oxy- 
gene  in  the  act  of  respiration. 

Mr.  Bonbome,  in  the  Chemical  Annals,  August,  1793,  sup- 
poses the  rickets  to  arise  from  the  prevalence  of  vegetable  or 
acetous  acid,  which  is  known  to  soften  bones  out  of  the  body. 
Mr.  Dettaen  seems  to  have  espoused  a similar  opinion,  and  both 
of  them  in  consequence  give  alkalies  and  testacea.  If  this  theory 
was  just,  the  soft  bones  of  such  patients  should  shew  evident 
marks  of  such  acidity  after  death;  which  I believe  has  not  been 
observed.  Nor  is  it  analogous  to  other  animal  facts,  that  nutri- 
tious fluids  secreted  by  the  finest  vessels  of  the  body  should  be  so 
little  animalized,  as  to  retain  acetous  or  vegetable  acidity. 

The  success  attending  the  following  case  in  so  short  a time  as 
a fortnight  I ascribed  principally  to  the  use  of  the  warm  bath; 
in  which  the  patient  continued  for  full  half  an  hour  every  night, 
in  the  degree  of  heat,  which  was  most  grateful  to  her  sensation, 

which  might  be  I suppose  about  94.  Miss , about  ten  years 

of  age,  and  very  tall  and  thin,  has  laboured  under  palpitation  of 
her  heart,  and  difficult  breathing  on  the  least  exercise,  with  oc- 
casional violent  dry  cough,  for  a year  or  more,  with  dry  lips, 
little  appetite  either  for  food  or  drink,  and  dry  skin,  with  cold 
extremities.  She  has  at  times  been  occasionally  worse,  and  been 
relieved  in  some  degree  by  the  bark.  She  began  to  bend  for- 
wards, and  to  lift  up  her  shoulders.  The  former  seemed  owing 
to  a beginning  curvature  of  the  spine,  the  latter  was  probably 
caused  to  facilitate  her  difficult  respiration. 

M.  M.  She  used  the  ivarm  bath,  as  above  related;  which  by 
its  warmth  might  increase  the  irritability  of  the  smallest  series 
of  vessels,  and  by  supplying  more  moisture  to  the  blood  might 
probably  tend  to  carry  further  the  materials,  which  form  calca- 
reous or  bony  particles,  or  to  convey  them  in  more  dilute  solu- 
tion. She  took  twice  a day  twenty  grains  of  extract  of  bark, 
twenty  grains  of  soda  phosphorata,  and  ten  grains  of  chalk  and 
ten  of  calcined  hartshorn,  mixed  into  a powder  with  ten  drops  ot 
laudanum;  with  flesh  food  both  to  dinner  and  supper;  and  port 
wine  and  water  instead  of  the  small  beer  she  had  been  accus- 
tomed to;  she  lay  on  a sofa  frequently  in  a day,  and  occasionally 
used  a neck-swing. 

There  is  no  situation,  where  the  softness  of  the  bones  and 
consequent  deformity  of  them  is  so  frequently  attended  with 
calamitous  consequences,  as  when  it  affects  the  bones  of  the 
pelvis,  so  as  to  contract  the  form  of  it;  whence  many  unfortu- 
nate women  have  lost  their  infants,  or  perished  themselves.  In 
this  miserable  situation  of  the  pregnant  uterus,  some  have  de- 
stroyed the  child,  others  have  undergone  the  Caesarean  operation, 


Class  I.  2.  2.  15. 


OF  IRRITATION. 


73 


and  have  thence  generally  perished  themselves.  But  Dr.  Den- 
man has  ingeniously  introduced  a new  practice,  w’hich  has  saved, 
in  such  cases,  both  the  mother  and  child;  which  is  by  promoting 
a premature  delivery  between  the  seventh  and  eighth  months, 
before  the  child  has  acquired  its  full  growth,  which  has  been  at- 
tended with  success.  See  Denman’s  Midwifery,  and  Medical 
Journal,  Vol.  III.  No.  11. 

In  one  instance  nature  seems  to  have  had  a similar  expedient, 
and  perhaps  to  overcome  a similar  difficulty,  in  the  premature 
birth  of  the  progeny  of  the  kangarroo;  whose  young  are  excluded 
from  the  uterus  in  a very  early  state  of  their  growth,  and  received 
into  an  exterior  bag;  which  is  furnished  with  teats,  to  which 
they  long  adhere  by  their  mouths,  till  they  are  ready  for  a second 
birth. 

15.  Rachitis.  Rickets.  The  head  is  large,  protuberant,  chiefly 
on  the  forepart.  The  smaller  joints  are  swelled;  the  ribs  de- 
pressed; the  belly  tumid,  with  other  parts  emaciated.  This  dis- 
ease from  the  innutrition  or  softness  of  the  bones  arose  about  two 
centuries  ago;  seems  to  have  been  half  a century  in  an  increas- 
ing or  spreading  state;  continued  about  half  a century  at  its 
height,  or  greatest  diffusion;  and  is  now  nearly  vanished:  which 
gives  reason  to  hope,  that  the  small-pox,  measles,  and  venereal 
disease,  which  are  all  of  modern  production,  and  have  already 
become  milder,  may  in  process  of  time  vanish  from  the  earth, 
and  perhaps  be  succeeded  by  new  ones!  See  the  preceding 
Species. 

16.  Spina  distortio.  Distortion  of  the  spine  is  another  disease 
originating  from  the  innutrition  or  softness  of  the  bones.  I once 
saw  a child  about  six  years  old  with  palpitation  of  heart,  and 
quickness  of  respiration,  which  began  to  have  a curvature  of  the 
spine;  1 then  doubted,  whether  the  palpitation  and  quick  respi- 
ration were  the  cause  or  consequence  of  the  curvature  of  the 
spine;  suspecting  either  that  nature  had  bent  the  spine  outwards 
to  give  room  to  the  enlarged  heart;  or  that  the  malformation  of 
the  chest  had  compressed  and  impeded  the  movements  of  the 
heart.  But  a few  weeks  ago  on  attending  a young  lady  about 
ten  years  old,  whose  spine  had  lately  begun  to  be  distorted,  with 
very  great  difficulty  and  quickness  of  respiration,  and  alarming 
palpitation  of  the  heart,  I convinced  myself,  that  the  palpitation 
and  difficult  respiration  were  the  effect  of  the  change  of  the 
cavity  of  the  chest  from  the  distortion  of  the  spine;  and  that  the 
whole  was  therefore  a disease  of  the  innutrition  or  softness  of  the 
bones. 

For  on  directing  her  to  lie  down  much  in  the  day,  and  to 
take  the  bark,  the  distortion  became  less,  and  the  palpitation  anti 
vol.  ir.  l 


DISEASES 


Class  I.  2.  2.  16. 


74 

quick  respiration  became  less  at  the  same  time.  After  this  ob- 
servation a neck-swing  was  directed,  and  she  took  the  bark, 
madder,  and  bone-ashes;  and  she  continues  to  amend  both  in  her 
shape  and  health. 

Delicate  young  ladies  are  very  liable  to  become  awry  at  many 
boarding-schools.  This  is  occasioned  principally  by  their  being 
obliged  too  long  to  preserve  an  erect  attitude,  by  sitting  on  forms 
many  hours  together.  To  prevent  this,  the  school-seats  should 
have  either  backs,  on  which  they  may  occasionally  rest  them- 
selves; or  desks  before  them,  on  which  they  may  occasionally 
lean.  This  is  a thing  of  greater  consequence  than  may  appear 
to  those  who  have  not  attended  to  it. 

When  the  least  tendency  to  become  awry  is  observed,  they  should 
be  advised  to  lie  down  on  a bed  or  sofa  for  an  hour  in  the  middle 
of  the  day  for  many  months;  which  generally  prevents  the  in- 
crease of  this  deformity  bv  taking  off  for  a time  the  pressure  on 
the  spine  of  the  back,  and  it  at  the  same  time  tends  to  make  them 
grow  taller.  Young  persons,  when  nicely  measured,  are  found 
to  be  half  an  inch  higher  in  a morning  than  at  night;  as  is  well 
known  to  those  who  enlist  very  young  men  for  soldiers.  This 
is  owing  to  the  cartilages  between  the  bones  of  the  back  becom- 
ing compressed  by  the  weight  of  the  head  and  shoulders  on  them 
during  the  day.  It  is  the  same  pressure  w'hich  produces  curva- 
tures and  distortions  of  the  spine  in  growing  children,  where 
the  bones  are  softer  than  usual;  and  which  may  thus  be  relieved 
by  an  horizontal  posture  for  an  hour  in  the  middle  of  the  day,  or 
by  being  frequently  allowed  to  lean  on  a chair,  or  to  play  on  the 
ground  on  a carpet. 

Young  ladies  should  also  be  directed,  where  two  sleep  in  a 
bed,  to  change  every  night,  or  every  week,  their  sides  of  the  bed; 
which  will  prevent  their  tendency  to  sleep  always  on  the  same 
side;  which  is  not  only  liable  to  produce  crookedness,  but  also 
to  occasion  diseases  by  the  internal  parts  being  so  long  kept  in 
uniform  contact  as  to  grow  together.  For  the  same  reason  they 
should  not  be  allowed  to  sit  always  on  the  same  side  of  the  fire 
or  window,  because  they  will  then  be  inclined  too  frequently  to 
bend  themselves  to  one  side. 

Another  great  cause  of  injury  to  the  shape  of  young  ladies  is 
from  the  pressure  of  stays,  or  other  tight  bandages,  which  at  the 
same  time  cause  other  diseases  by  changing  the  form  or  situation 
of  the  internal  parts.  If  a hard  part  of  the  stays,  even  a knot 
of  the  thread,  with  which  they  are  sewed  together,  is  pressed 
hard  upon  one  side  more  than  the  other,  the  child  bends  from 
the  side  most  painful,  and  thus  occasions  a curvature  of  the  spine. 
To  counteract  this  effect,  such  stays  as  have  fewest  hard  parts, 


OP  IRRITATION. 


Ciass  I.  2.  2. 16. 


75 


and  especially  such  as  can  be  daily  or  weekly  turned,  are  prefera- 
ble to  others. 

Where  frequent  lying  down  on  a sofa  in  the  day-time,  and 
swinging  frequently  for  a short  time  by  the  hands  or  head,  with 
loose  dress,  do  not  relieve  a beginning  distortion  of  the  back;  re- 
course may  be  had  to  a chair  with  stuffed  moveable  arms  for  the 
purpose  of  suspending  the  weight  of  the  body  by  cushions  under 
the  arms-pits,  like  resting  on  curtehes,  or  like  the  leading-strings 
of  infants.  From  the  top  of  the  back  of  the  same  chair  a curved 
steel  bar  may  also  project  to  suspend  the  body  occasionally  or  in 
part  by  the  head,  like  the  swing  above  mentioned.  The  use  of 
this  chair  is  more  efficacious  in  straightening  the  spine,  than  simply 
lying  down  horizontally;  as  it  not  only  takes  off  the  pressure  of 
the  head  and  shoulders  from  the  spine,  but  at  the  same  time  the 
inferior  parts  of  the  body  contribute  to  draw  the  spine  straight  by 
their  weight;  or  lastly,  recourse  may  be  had  to  a spinal  machine 
first  described  in  the  Memoires  of  the  Academy  of  Surgery  in 
Paris,  Vol.  III.  p.  600,  by  M.  Le  Yacher,  and  since  made  by 
Mr.  Jones,  at  No.  6,  North-street,  Tottenham  court-road,  Lon- 
don, which  suspends  the  head,  and  places  the  weight  of  it  on  the 
hips.  This  machine  is  capable  of  improvement  by  joints  in  the 
bar  at  the  back  of  it,  to  permit  the  body  to  bend  forwards  with- 
out diminishing  the  extension  of  the  spine. 

The  objections  of  this  machine  of  M.  Vacher,  which  is  made 
by  Mr.  Jones,  are  first,  that  it  is  worn  in  the  day-time,  and  has  a 
very  unsightly  appearance.  Mr.  Jones  has  endeavoured  to  remedy 
this,  by  taking  away  the  curved  bar  over  the  head,  and  substitut- 
ing in  its  place  a forked  bar,  rising  up  behind  each  ear,  with 
webs  fastened  to  it,  which  pass  under  the  chin  and  occiput.  But 
this  is  not  an  improvement,  but  a deterioration  of  M.  Vacher’s 
machine,  as  it  prevents  the  head  from  turning  with  facility  to 
either  side.  Another  objection  is,  that  its  being  worn,  when  the 
muscles  of  the  back  are  in  action,  it  is  rather  calculated  to  pre- 
vent the  curvature  of  the  spine  from  becoming  greater,  than  tq 
extend  the  spine,  and  diminish  its  curvature. 

For  this  latter  purpose  I have  made  a steel  bow,  which  re- 
ceives the  head  longitudinally  from  the  forehead  to  the  occiput; 
having  a fork  furnished  with  a web  to  sustain  the  chin,  and 
another  to  sustain  the  occiput.  The  summit  of  the  bow  is  fixed 
by  a swivel  to  the  board  going  behind  the  head  of  the  bed  above 
the  pillow.  The  bed  is  to  be  inclined  from  the  head  to  the  feet 
about  twelve  or  sixteen  inches.  Hence  the  patient  would  be 
constantly  sliding  dowm  during  sleep,  unless  supported  by  this 
bow,  with  webbed  forks,  covered  also  with  fur,  placed  beneath 
ihe  chin,  and  beneath  the  occiput.  There  are  also  proper  webs 


7 8 


DISEASES 


Class  I.  2.  2.  IS. 


lined  with  fur  for  the  hands  to  take  hold  of  occasionally,  and 
also  to  go  under  the  arms.  By  these  means  I should  hope  great 
advantage  from  gradually  extending  the  spine  during  the  inac- 
tivity  of  the  muscles  of  the  back;  and  that  it  may  be  done  with- 
out disturbing  the  sleep  of  the  patient,  and  if  this  should  hap- 
pen, the  bow  is  made  to  open  by  a joint  at  the  summit  of  it,  so  as 
to  be  instantly  disengaged  from  the  neck  by  the  hand  of  the 
wearer.  This  bow  I have  now  used  with  advantage  on  one  pa- 
tient, and  it  may  be  had  from  Mr.  Harrison,  whitesmith,  Bridge- 
gate,  Derby. 

It  is  also  possible  that  a slight  compress  on  the  prominent  part 
of  a curved  spine  might  be  applied  with  advantage  both  in  sleep 
and  in  waking  hours,  if  it  could  be  nicely  held  on  the  part  by  a 
weak  and  very  flexible  spring,  with  a proper  counter-pressure  on 
some  distant  part;  but  this  would  require  more  art  than  could  be 
managed,  except  by  those  who  have  very  accurate  mechanical 
ideas,  and  must  differ  with  every  kind  of  curvature.  Thus  if  the 
prominent  part  of  the  curve  of  the  spine  be  on  one  side,  a stuffed 
cushion  fixed  to  the  centre  of  a long  thin  steel  spring  should  be 
applied  on  the  prominence;  one  end  of  this  long  spring  should  be 
bent  by  a strap  joined  to  a waistcoat  on  the  opposite  shoulder, 
and  the  other  end  of  it  by  a strap  joined  to  drawers  on  the  op- 
posite hip;  the  degree  of  pressure  to  be  adjusted  by  the  tightness 
of  these  straps.  If  the  prominent  part  of  a curved  spine  be  ex- 
actly behind,  the  ends  of  the  long  spring  should  extend  from  the 
lowest  bone  of  the  neck  to  the  os  coccigis,  and  should  have  its 
two  ends  attached  to  the  top  of  a waistcoat,  and  to  the  ivaistband 
of  a pair  of  drawers. 

It  will  be  from  hence  easily  perceived,  that  all  other  methods 
of  confining  or  directing  the  growth  of  young  people  should  be 
used  with  great  skill;  such  as  back-boards,  or  bandages,  or  stocks 
for  the  feet;  and  that  their  application  should  not  be  continued 
too  long  at  a time,  lest  worse  consequences  should  ensue,  than 
the  deformity  they  were  designed  to  remove.  To  this  may  be 
added,  that  the  stiff  erect  attitude  taught  by  some  modern  danc- 
ing masters  does  not  contribute  to  the  grace  of  person,  but 
rather  militates  against  it;  as  is  well  seen  in  one  of  the  prints 
in  Hogarth’s  Analysis  of  Beauty;  and  is  exemplified  by  the 
easy  grace  of  some  of  the  ancient  statutes,  as  of  the  Venus  de 
Medicis,  and  the  Antinous,  and  in  the  works  of  some  modern 
artists,  as  in  a beautiful  print  of  Hebe  feeding  an  Eagle,  painted 
by  Hamilton,  and  engraved  by  Eginton,  and  many  of  the  figures 
of  Angelica  Kauffman. 

Where  the  bone  of  one  of  the  vertebras  of  the  back  has  been 
swelled  on  both  sides  of  it,  30  as  to  become  protuberant,  issues 


Class.  1. 2.  2.  17. 


OF  IRRITATION. 


71 


near  the  swelled  part  have  been  found  of  great  service,  as  men- 
tioned in  Species  18  of  this  Genus.  This  has  induced  me  to 
propose  in  curvatures  of  the  spine,  to  put  an  issue  on  the  outside 
of  the  curve,  where  it  could  be  certainly  ascertained,  as  the  bones 
on  the  convex  side  of  the  curve  must  be  enlarged;  in  one  case  1 
thought  this  of  service,  and  recommended  the  further  trial  of  it. 

In  the  tendency  to  curvature  of  the  spine,  whatever  strength- 
ens the  general  constitution  is  of  service;  as  the  use  of  the  cold 
bath  in  the  summer  months.  This  however  requires  some  re- 
striction both  in  respect  to  the  degree  of  coldness  of  the  bath, 
the  time  of  continuing  in  it,  and  the  season  of  the  year.  Com- 
mon springs,  which  are  of  forty-eight  degrees  of  heat,  are  too 
cold  for  tender  constitutions,  whether  of  children  or  adults,  and 
frequently  do  them  great  and  irreparable  injury.  The  coldness 
of  river-water  in  the  summer  months,  which  is  about  sixty-eight 
degrees,  or  that  of  Matlock,  which  is  about  sixty-eight,  or  of 
JBuxton,  which  is  eighty-two,  are  much  to  be  preferred.  The 
time  of  continuing  in  the  bath  should  be  but  a minute  or  two, 
or  not  so  long  as  to  occasion  a trembling  of  the  limbs  from  cold. 
In  respect  to  the  season  of  the  year,  delicate  children  should 
certainly  only  bathe  in  the  summer  months;  as  the  going  fre- 
quently into  the  cold  air  in  winter  will  answer  all  the  purposes 
of  the  cold  bath. 

17.  Claudicatio  coxaria.  Lameness  of  the  hip.  A nodding 
of  the  thigh  bone  is  said  to  be  produced  in  feeble  children  by  the 
softness  of  the  neck  or  upper  part  of  that  bone  beneath  the  car- 
tilage; which  is  naturally  bent,  and  in  this  disease  bends  more 
downwards,  or  nods,  by  the  pressure  of  the  body;  and  thus 
renders  one  leg  apparently  shorter  than  the  other.  In  other 
cases  the  end  of  the  bone  is  protruded  out  of  its  socket,  by  in- 
flammation or  enlargement  of  the  cartilages  or  ligaments  of  the 
joint,  so  that  it  rests  on  some  part  of  the  edge  of  the  acetabu- 
lum, which  in  time  becomes  filled  up.  When  the  legs  are 
straight,  as  in  standing  erect,  there  is  no  verticillary  motion  in 
the  knee-joint;  all  the  motion  then  in  turning  out  the  toes  fur- 
ther than  nature  designed,  must  be  obtained  by  straining  in  some 
degree  this  head  of  the  thigh-bone,  or  the  acetabulum,  or  cavity, 
in  which  it  moves.  This  has  induced  me  to  believe  that  this 
misfortune  of  the  nodding  of  the  head  of  the  bone,  or  partial  dis- 
location of  it,  by  which  one  leg  becomes  shorter  than  the  other, 
is  sometimes  occasioned  by  making  very  young  children  stand  in 
what  are  called  stocks;  that  is  with  their  heels  together,  and 
their  toes  quite  out.  Whence  the  socket  of  the  thigh-bone  be- 
comes inflamed  and  painful,  or  the  neck  of  the  bone  is  bent 
downward  and  outwards. 


78 


DISEASES 


Class  I.  2.  2.  lb. 


la  this  case  there  is  no  expectation  of  recovering  the  straight- 
ness of  the  end  of  the  bone;  but  these  patients  are  liable  to 
another  misfortune,  that  is,  to  acquire  afterwards  a distor- 
tion of  the  spine;  for  as  one  leg  is  shorter  than  the  other,  they 
sink  on  that  side,  and  in  consequence  bend  the  upper  part  of 
their  bodies,  as  their  shoulders,  the  contrary  way,  .o  balance 
themselves;  and  then  again  the  neck  is  bent  back  again  towards 
the  lame  side,  to  preserve  the  head  perpendicular;  and  thus  the 
figure  becomes  quite  distorted  like  the  letter  S,  owing  originally 
to  the  deficiency  of  the  length  of  one  limb.  The  only  way  to 
prevent  this  curvature  of  the  spine  is  for  the  child  to  wear  a 
high-heeled  shoe  or  patten  on  the  lame  foot,  so  as  to  support  that 
side  on  the  same  level  with  the  other,  and  thus  to  prevent  a 
greater  deformity. 

I have  this  day  seen  a young  lady  about  twelve,  who  does  not 
limp  or  waddle  in  walking;  but  nevertheless,  when  she  stands 
or  sits,  she  sinks  down  towards  her  right  side,  and  turns  out  that 
toe  more  than  the  other.  Hence,  both  as  she  sits  and  stands, 
she  bends  her  body  to  the  right;  whence  her  head  would  hang 
a little  over  her  right  shoulder;  but  to  replace  this  perpendicu- 
larly, she  lifts  up  her  left  shoulder  and  contracts  the  muscles  on 
that  side  of  the  neck;  which  are  therefore  become  thicker  and 
stronger  by  their  continued  action;  but  there  is  not  yet  any  very 
perceptible  distortion  of  the  spine. 

As  her  right  toe  is  turned  outward  rather  more  than  natural, 
this  shews  the  disease  to  be  in  the  hip-joint;  because,  when  the 
limb  is  stretched  out,  the  toe  cannot  turn  horizontally  in  the 
least  without  moving  the  end  of  the  thigh-bone;  although  when 
the  knee  is  bent,  the  toe  can  be  turned  through  one-third  or  half 
of  a circle  by  the  rotation  of  the  tibia  and  fibula  of  the  leg  round 
each  other.  Hence  if  children  are  set  in  stocks  w'ith  their  heels 
touching  each  other  as  they  sit,  and  are  then  made  to  rise  up,  till 
they  stand  erect,  the  socket  or  head  of  the  thigh-bone  becomes 
injured,  especially  in  those  children,  whose  bones  are  soft;  and 
a shortness  of  that  limb  succeeds  either  by  the  bending  of  the 
neck  of  the  thigh-bone,  or  by  its  getting  out  of  the  acetabulum; 
and  a consequent  rising  of  one  shoulder,  and  a curvature  of  the. 
spine  are  produced  from  so  distant  a cause. 

M.  M.  An  elastic  cushion  made  of  curled  hair,  should  be 
placed  under  the  affected  hip,  whenever  she  sits;  or  should  be  fit- 
ted to  the  part  by  means  of  drawers,  so  that  she  could  not  avoid 
sitting  on  it.  A neck-swing  and  lying  down  in  the  day,  should 
be  occasionally  used  to  prevent  or  remove  any  curvature  of  the 
spine.  The  rest  as  in  Species  13  and  15  of  this  genus. 

18.  Spina  protuberant.  Protuberant  spine.  One  of  the  bones 


Giass  I.  2.  2.  19. 


OF  IRRITATION. 


79 


of  the  spine  swells,  and  rises  above  the  rest.  This  is  not  an  un- 
common disease,  and  belongs  to  the  innutrition  of  the  bones,  as 
the  bone  must  become  soft  before  it  swells;  which  softness  is 
owing  to  defect  of  the  secretion  of  phosporated  calcareous  earth. 
The  swelling  of  the  bone  compresses  a part  of  the  brain,  called 
the  spinal  marrow,  within  the  cavity  of  the  back  bones;  and  in 
consequence  the  lower  limbs  become  paralytic,  attended  some- 
times with  difficulty  of  emptying  the  bladder  and  rectum. 

M.  M.  Issues  put  on  each  side  of  the  prominent  bone  are  of 
great  effect,  I suppose,  by  their  stimulus;  which  excites  into 
action  more  of  the  sensorial  powers  of  irritation  and  sensation, 
and  thus  gives  greater  activity  to  the  vascular  system  in  their 
vicinity.  The  methods  recommended  in  distortion  of  the  spine 
are  also  to  be  attended  to. 

19.  Spina  bifida.  Divided  spine,  called  also  Hydrorachitis,  as 
well  as  the  Hydrocephalus  externus,  is  probably  owing  in  part 
to  a defect  of  ossification  of  the  spine  and  cranium;  and  the  col- 
lection of  fluid  beneath  them  may  originate  from  the  general  de- 
bility of  the  system;  which  affects  both  the  secerning  and  absor- 
bent vessels. 

A curious  circumstance,  which  is  affirmed  to  attend  the  spina 
bifida,  is,  that  on  compressing  the  tumour  with  the  hand  gently, 
the  whole  brain  becomes  affected,  and  the  patient  falls  asleep.  I 
suppose  the  same  must  happen  on  compressing  the  hydrocephalus 
externus?  See  Sect.  XVIII.  20. 

20.  Ossis  palati  defectus.  A defect  of  the  bone  of  the  palate, 
which  frequently  accompanies  a division  of  the  upper  lip,  occurs 
before  nativity;  and  is  owing  to  the  deficient  action  of  the  secern- 
ing system,  from  whence  the  extremities  are  not  completed. 
From  a similar  cause  I have  seen  the  point  of  the  tongue  deficient, 
and  one  joint  of  the  two  least  fingers,  and  of  the  two  least  toes, 
in  the  same  infant;  who  was  otherwise  a fine  girl.  See  Sect. 
XXXIX.  4.  4. 

The  operation  for  the  hair-lip  is  described  by  many  surgical 
writers;  but  there  is  a person  in  London,  wrho  makes  very  in- 
genious artificial  palates;  which  prevent  that  defect  of  speech, 
which  attends  this  malformation.  This  factitious  palate  consists  of 
a thin  plate  of  silver  of  the  shape  and  form  of  the  roof  of  the  mouth; 
from  the  front  edge  to  the  back  edge  of  this  silver  plate  four 
or  five  holes  are  made  in  a straight  line  large  enough  for  a needle 
to  pass  through  them;  on  the  back  of  it  is  then  sewed  a piece  of 
sponge;  which,  when  expanded  with  moisture,  is  nearly  as  large 
as  the  silver  plate.  This  sponge  is  slipped  through  the  division 
of  the  bone  of  the  palate,  so  as  to  lie  above  it,  while  the  silver 


80 


DISEASES 


Class  I.  2.  2.  20. 


plate  covers  the  aperture  beneath,  and  is  suspended  by  the  ex- 
panding sponge.  This  is  removed  every  night  and  washed,  and 
returned  into  its  place  in  the  morning;  on  this  account  it  is  con- 
venient to  have  five  or  six  of  them,  for  the  sake  of  cleanliness.  I 
have  been  more  particular  in  describing  this  invention,  as  I do 
not  know  the  name,  or  place  of  residence,  of  the  maker. 


Ciass  I,  2.  3.  1. 


OF  IRRITATION. 


81 


ORDO  II. 

Decreased  Irritation . 

GENUS  III. 


With  decreased  Action  of  the  Absorbent  System. 


Some  decrease  of  heat  attends  these  diseases,  though  in  a less 
degree  than  those  of  the  last  genus,  because  the  absorbent  system 
of  glands  do  not  generate  so  much  heat  in  their  healthy  state  of 
action  as  the  secerning  system  of  glands,  as  explained  in  Class 

I.  I.  3. 


SPECIES. 


1.  Mucus  faucium  frigidus.  Cold  mucus  from  the  throat. 
Much  mucus,  of  rather  a saline  taste,  and  less  inspissated  than 
usual,  is  evacuated  from  the  fauces  by  hawking,  owing  to  the 
deficient  absorption  of  the  thinner  parts  of  it.  This  becomes  a 
habit  in  some  elderly  people,  who  are  continually  spitting  it  out 
of  their  mouths;  and  has  probably  been  brought  on  by  taking 
snuff,  or  smoking  tobacco;  which,  by  frequently  stimulating  the 
fauces,  have  at  length  rendered  the  absorbent  vessels  less  excita- 
ble by  the  natural  stimulus  of  the  saline  part  of  the  secretion, 
which  ought  to  be  reabsorbed,  as  soon  as  secreted. 

M.  M.  A few  grains  of  powder  of  bark  frequently  put  into 
the  mouth,  and  gradually  diffused  over  the  fauces.  A gargle  of 
barley  water. 

2.  Sudor  frigidus.  The  cold  dampness  of  the  hands  of  some 
people  is  caused  by  the  deficient  absorption  of  perspirable  matter; 
the  clammy  or  viscid  feel  of  it  is  owing  to  the  mucus  part  being 
left  upon  the  skin.  The  coldness  is  produced  both  by  the  de- 
creased action  of  the  absorbent  system,  and  by  the  evaporation  of 
a greater  quantity  of  the  perspirable  matter  into  the  air,  which 
ought  to  have  been  absorbed. 

M.  M.  Wash  the  hands  in  lime  water,  or  with  a small  quan- 
tity of  volatile  alkali  in  water. 

3.  Catarrhus  frigidus.  The  thin  discharge  from  the  nostrils 
in  cold  weather.  The  absorbent  vessels  become  torpid  by  the 
diminution  of  external  heat,  sooner  than  the  secerning  ones, 
which  are  longer  kept  warm  by  the  circulating  blood,  from 
which  they  select  the  fluid  they  secrete;  whereas  the  absorbent 

VOL.  II.  m 


82 


DISEASES 


Class  I.  2.  3.  & 


vessels  of  the  nostrils  drink  up  their  fluids,  namely,  the  thin  and 
saline  part  of  the  mucus,  after  it  has  been  cooled  by  the  atmo- 
sphere. Hence  the  absorbents  ceasing  to  act,  and  the  secerning 
vessels  continuing  some  time  longer  to  pour  out  the  mucus,  a 
copious  thin  discharge  is  produced,  which  trickles  down  the 
nostrils  in  cold  weather.  This  discharge  is  so  acrid  as  to  in- 
flame the  upper  lip;  which  is  owing  to  the  neutral  salts,  with 
which  it  abounds,  not  being  reabsorbed;  so  the  tears  in  the  fistula 
lachrymalis  inflame  the  cheek.  See  Class  I.  1.2.  7. 

4.  Expectoratio  frigida.  Cold  expectoration.  Where  the 
pulmonary  absorption  is  deficient,  an  habitual  cough  is  produced, 
and  a frequent  expectoration  of  thin  saline  mucus;  as  is  often 
seen  in  old  enfeebled  people.  Though  the  stimulus  of  the  saline 
fluid,  which  attends  all  secretions,  is  not  sufficient  to  excite  the 
languid  absorbent  vessels  to  imbibe  it;  yet  this  saline  part,  to- 
gether with  the  increased  quantity  of  the  whole  of  the  secreted 
mucus,  stimulates  the  branches  of  the  bronchia,  so  as  to  induce 
an  almost  incessant  cough,  to  discharge  it  from  the  lungs.  A 
single  grain  of  opium,  or  any  other  stimulant  drug,  as  a wine 
posset  with  spirit  of  hartshorn,  will  cure  this  cold  cough,  and  the 
cold  catarrh  of  the  preceding  article,  like  a charm,  by  stimula- 
ting the  torpid  mouths  of  the  absorbents  into  action.  Which 
has  given  rise  to  an  indiscriminate,  and  frequently  pernicious,  use 
of  the  warm  regimen  in  coughs  and  catarrhs  of  the  warm  or  in- 
flammatory kind,  to  the  great  injury  of  many. 

M.  M.  Half  a grain  of  opium  night  and  morning  promotes 
the  absorption  of  the  more  fluid  and  saline  parts,  and  in  conse- 
quence thickens  the  mucus,  and  abates  its  acrimony.  Warm 
diluent  drink,  wine-whey,  with  volatile  alkali. 

5.  Urina  ubenor  pallida.  On  being  exposed  naked  to  cold 
air,  or  sprinkled  with  cold  wTater,  a quantity  of  pale  urine  is  sooa 
discharged;  for  the  absorbents  of  the  bladder  become  torpid  by 
their  sympathy  with  those  of  the  skin;  which  are  rendered  qui- 
escent by  the  diminution  of  external  heat;  but  the  kidneys  con- 
tinue to  secrete  the  urine,  and  as  no  part  of  it  is  absorbed,  it  be- 
comes copious  and  pale.  This  happens  from  a similar  cause  in 
cold  fits  of  agues;  and  in  less  degree  to  many  debilitated  consti- 
tutions, whose  extremities  are  generally  cold  and  pale.  The 
great  quantity  of  limpid  water  in  hysteric  cases,  and  in  diabetes, 
belongs  to  Class  I.  3.  1.  10.  I.  3.  2.  6. 

M.  M.  Tincture  of  cantharides,  opium,  alum,  sorbentia. 
Flannel  shirt  in  cold  weather.  Animal  food.  Beer.  Wine, 
Friction.  Exercise.  Fire. 

6.  Diarrhoea  frigida.  Liquid  stools  are  produced  by  exposing 


Ciass  I.  2. 3. 7.  OF  IRRITATION.  83 

the  body  naked  to  cold  air,  or  sprinkling  it  with  cold  water,  for 
the  same  reason  as  the  last  article. 

But  this  disease  is  sometimes  of  a dangerous  nature;  the  in- 
testinal absorption  being  so  impaired,  that  the  aliment  is  said  to 
come  away  undiminished  in  quantity,  and  almost  unchanged  by 
the  powers  of  digestion,  and  is  then  called  lientery. 

The  mucus  of  the  rectum  sometimes  comes  away  like  pellu- 
cid hartshorn  jelly,  and  liquifies  by  heat  like  that,  towards  the 
end  of  inirritative  fevers,  which  is  owing  to  the  thinner  part  of 
the  mucus  not  being  absorbed,  and  thus  resembles  the  catarrh  of 
some  old  people. 

M.  M.  Opium,  campechy  wood,  armenian  bole.  Blister. 
Flannel  shirt  in  cold  weather.  Clysters  with  opium.  Friction 
on  the  bowels  morning  and  night.  Equitation  twice  a day. 

7.  Fluor  albus  frigidus.  Cold  fluor  albus.  In  weak  constitu- 
tions, where  this  discharge  is  pellucid  and  thin,  it  must  proceed 
from  want  of  absorption  of  the  mucous  membrane  of  the  vagina, 
or  uterus,  and  not  from  an  increased  secretion.  This  I suspect 
to  be  the  most  frequent  kind  of  fluor  albus;  the  former  one  de- 
scribed at  Class  I.  1.  2.  11.  attends  menstruation,  or  is  a dis- 
charge instead  of  it,  and  thus  resembles  the  venereal  orgasm  of 
female  quadrupeds.  The  discharge  in  the  cold  kind  being  more 
saline,  is  liable  to  excoriate  the  part,  and  thus  produce  smarting 
in  making  water;  in  its  great  degree  it  is  difficult  to  cure. 

M.  M.  Increase  the  evacuation  by  stool  and  by  perspiration, 
by  taking  rhubarb  every  night,  about  six  or  ten  grains  with  one 
grain  of  opium  for  some  months.  Flannel  shirt  in  winter.  Balsam 
copaiva.  Gum  kino,  bitters,  chalybeates,  friction  over  the  whole 
skin  with  flannel  morning  and  night.  Partial  cold  bath,  by 
sprinkling  the  loins  and  thighs,  or  sponging  them  with  cold 
water.  Mucilage,  as  isinglass  boiled  in  milk;  blanc  mange 
hartshorn  jelly,  are  recommended  by  some.  Tincture  of  can- 
tharides  sometimes  seems  of  service  given  from  ten  to  twenty 
drops  or  more,  three  or  four  times  a day.  A large  plaster  of 
burgundy  pitch  and  armenian  bole,  so  as  to  cover  the  loins  and 
lower  part  of  the  belly,  is  said  to  have  sometimes  succeeded  by 
increasing  absorption  by  its  compression  in  the  manner  of  a band- 
age. A solution  of  metallic  salts,  as  white  vitriol,  sixty  grains 
to  a pint;  or  an  infusion  of  oak-bark  may  be  injected  into  the 
vagina.  Cold  bath. 

8.  Gonorrhoea  frigida.  Cold  gleet.  Where  the  gleet  is  thin 
and  pellucid,  it  must  arise  from  the  want  of  absorption  of  the 
membranes  of  the  urethra,  rather  than  from  an  increased  secre- 
tion from  them.  This  I suppose  to  be  a more  common  disease 
than  that  mentioned  at  Class  I.  1.  2.  10. 


84 


DISEASES 


Class  I.  2.  3.  9. 


M.  M.  Metallic  injections,  partial  cold  bath,  internal  method 
as  in  the  fluor  albus  above  described.  Balsam  of  copaiva.  Tinc- 
ture of  cantharides.  Introduce  a few  inches  into  the  urethra  a 
bougie  smeared  with  balsam  of  copaiva.  See  Home  on  Urethra, 
p.  105. 

9.  Hepatis  tumor.  The  liver  becomes  enlarged  from  defect 
of  the  absorption  of  mucus  from  its  cells,  as  in  anasarca,  espe- 
cially in  feeble  children;  at  the  same  time  less  bile  is  secreted 
from  the  torpid  circulation  in  the  vena  portae.  And  as  the  ab- 
sorbents which  resume  the  thinner  parts  of  the  bile  from  the 
gall-bladder  and  hepatic  ducts,  are  also  torpid  or  quiescent,  the 
bile  is  more  dilute,  as  weil  as  in  less  quantity.  From  the  ob- 
struction of  the  passage  of  the  blood  through  the  compressed  ve- 
na porta  these  patients  have  tumid  bellies,  and  pale  bloated  coun- 
tenances; their  paleness  is  probably  owing  to  the  deficiency  of 
the  quantity  of  red  globules  in  the  blood  in  consequence  of  the 
inert  state  of  the  bile. 

These  symptoms  in  children  are  generally  attended  with 
worms,  the  dilute  bile  and  the  weak  digestion  not  destroying 
them.  In  sheep  I have  seen  fluke-worms  in  the  gall-ducts  them- 
selves among  the  dilute  bile;  which  gall-ducts  they  eat  through, 
and  then  produce  ulcers,  and  the  hectic  fever  called  the  rot. 
See  Class  I.  1.4.  10.  and  Article  IV.  2.  6. 

M.  M.  After  a calomel  purge,  crude  iron  filings  are  specific 
in  this  disease  in  children,  and  the  worms  are  destroyed  by  the 
returning  acrimony  and  quantity  of  the  bile.  A blister  on  the 
region  of  the  liver.  Sorbentia,  as  worm-seed,  santonicum.  Co- 
lumbo.  Bark. 

The  nitrous  acid  has  been  strongly  recommended  by  Mr.  Scot 
in  tumours  of  the  liver,  which  frequently  occur  in  the  east,  where 
this  gentleman  resides;  he  gives  two  drachms  of  strong  nitrous 
acid  mixed  wiih  two  pounds  of  water,  to  be  drunk  daily  at  in- 
tervals. See  Syphilis,  Class  II.  1.  5.  2. 

10.  Chlorosis.  When  the  defect  of  the  due  action  of  both  the 
absorbent  and  secerning  vessels  of  the  liver  affects  women,  and  is 
attended  with  obstruction  of  the  catamenia,  it  is  called  chlorosis; 
and  is  cured  by  the  exhibition  of  steel,  which  restores  by  its  spe- 
cific stimulus  the  absorbent  power  of  the  liver;  and  the  men- 
struation, which  was  obstructed  in  consequence  of  debility, 
recurs. 

Indigestion,  owing  to  torpor  of  the  stomach,  and  a consequent 
too  great  acidity  of  its  contents,  attend  this  disease;  whence  a 
desire  of  eating  chalk,  or  marl.  Sometimes  a great  quantity  of 
pale  urine  is  discharged  in  a morning,  which  is  owing  to  the  in- 
action of  the  absorbents,  which  are  distributed  on  the  neck  of 


Ciass  I.  2.  3. 11. 


OF  IRRITATION. 


85 


the  bladder,  during  sleep.  The  swelling  of  the  ankles,  which 
frequently  attends  chlorosis,  is  another  effect  of  deficient  action 
of  the  absorbent  system;  and  the  pale  countenance  is  occasioned 
by  the  deficient  quantity  of  red  globules  of  blood  caused  by  the 
deficient  quantity  or  acrimony  of  the  bile,  and  consequent  weak- 
ness of  the  circulation.  The  pulse  is  so  quick  in  some  cases  of 
chlorosis,  that  when  attended  with  an  accidental  cough,  it  may 
be  mistaken  for  pulmonary  consumption.  This  quick  pulse  is 
owing  to  the  debility  of  the  heart  from  the.  want  of  stimulus,  oc- 
casioned by  the  deficiency  of  the  quantity,  and  acrimony  of  the 
blood. 

M.  M.  Steel.  Bitters.  Constant  moderate  exercise.  Fric- 
tion with  flannel  all  over  the  body  and  limbs  night  and  morn- 
ing. Rhubarb  five  grains,  opium  half  a grain,  every  night. 
Flesh  diet,  with  small  beer,  or  wine  and  water.  The  disease 
continues  some  months,  but  at  length  subsides  by  the  treatment 
above  described.  A bath  of  about  eighty  degrees,  as  Buxton 
bath,  is  of  service;  a colder  bath  may  do  great  injury. 

11.  Hydrocele.  Dropsy  of  the  vagina  testis.  Dropsies  have 
been  divided  into  the  encysted  and  the  diffused,  meaning  those  of 
the  cellular  membrane,  the  cells  of  which  communicate  with  each 
other  like  a sponge,  and  those  of  any  other  cavity  of  the  body. 
The  collections  of  mucous  fluids  in  the  various  cells  and  cavities 
of  the  body  arise  from  the  torpor  of  the  absorbent  vessels  of  those 
parts.  It  is  probable,  that  in  dropsies  attended  with  great  thirst, 
the  cutaneous  absorbents  become  paralytic  first;  and  then  from 
the  great  thirst,  which  is  thus  occasioned  by  the  want  of  atmos- 
pheric moisture,  the  absorption  of  the  fat  ensues;  as  in  fevers 
attended  with  great  thirst,  the  fat  is  quickly  taken  up.  See  Obe- 
sitas  I.  2.  3.  16.  Some  have  believed,  that  the  cellular  and  adi- 
pose membranes  are  different  ones;  as  no  fat  is  ever  deposited 
in  the  eyelids  or  scrotum,  both  which  places  are  very  liable  to 
be  distended  with  the  mucilaginous  fluid  of  the  anasarca,  and  with 
air  in  emphysema.  Sometimes  a gradual  absorption  of  the  ac- 
cumulated fluid  takes  place,  and  the  thinner  parts  being  taken 
tip,  there  remains  a more  viscid  fluid,  or  almost  a solid  in  the 
part,  as  in  some  swelled  legs,  which  cannot  easily  be  indented  by 
the  pressure  of  the  finger,  and  are  called  scorbutic.  Sometimes 
the  paralysis  of  the  absorbents  is  completely  removed,  and  the 
whole  is  again  taken  up  into  the  circulation. 

The  hydrocele  is  knowm  by  a tumour  of  the  scrotum,  which 
is  without  pain,  gradually  produced,  with  fluctuation,  and  a de- 
gree of  peliucidiiy,  when  a candle  is  held  behind  it;  it  is  the 
most  simple  encysted  dropsy,  as  it  is  not  in  general  complicated 
with  other  diseases,  as  ascites  with  scirrhous  fever,  and  hydro- 


61) 


DISEASES 


Ceass  I.  1.  3.  12. 


cephalus  internus,  with  great  debility.  The  cure  of  this  dis- 
ease is  affected  by  different  ways;  it  consists  in  discharging  the 
water  by  an  external  aperture;  and  by  so  far  inflaming  the  cyst 
and  testicle,  that  they  afterwards  grow  together,  and  thus  pre- 
vent in  future  any  secretion  or  effusion  of  mucus;  the  disease  is 
thus  cured,  not  by  the  revivescence  of  the  absorbent  power  of  the 
lymphatics,  but  by  the  prevention  of  secretion  by  the  adhesion  of 
the  vagina  to  the  testis.  This  I believe  is  performed  with  less 
pain,  and  is  more  certainly  managable  by  tapping,  or  discharg- 
ing the  fluid  by  means  of  atrochar,  and  after  the  evacuation  of  it 
to  fill  the  cyst  with  a mixture  of  wine  and  water  for  a few  mi- 
nutes till  the  necessary  degree  of  stimulus  is  produced,  and  then 
to  withdraw  it;  as  recommended  by  Mr.  Earle.  See  also  Medi- 
cal Commentaries  by  Dr.  Duncan  for  1793. 

12.  Hydrocephalus  internus , or  dropsy  of  the  ventricles  of  the 
brain,  is  fatal  to  many  children  and  some  adults.  When  this 
disease  is  less  in  quantity,  it  probably  produces  a fever,  termed  a 
nervous  fever,  and  which  is  sometimes  called  a worm  fever,  ac- 
cording to  the  opinion  of  Dr.  Gilchrist,  in  the  Scots  Medical 
Essays.  This  fever  is  attended  with  great  inirritability,  as  appears 
from  the  dilated  pupils  of  the  eyes,  in  which  it  corresponds  with 
the  dropsy  of  the  brain.  And  the  latter  disease  has  its  p iroxvsms 
of  quick  impulse,  and  in  that  respect  corresponds  with  other 
fevers  with  inirritabilitv. 

The  hydrocephalus  internus  is  distinguished  from  apoplexy  by 
its  being  attended  with  fever,  and  from  nervous  fever  by  the 
paroxysms  being  very  irregular,  with  perfect  intermissions  many 
times  in  a day.  In  nervous  fever  the  pain  of  the  head  generally 
affects  the  middle  of  the  forehead;  in  hydrocephalus  internus  it 
is  generally  on  one  side  of  the  head.  One  of  the  earliest  crite- 
rions  is  the  patient  being  uneasy  on  raising  his  head  from  the  pil- 
low, and  wishing  to  lie  down  again  immediately;  which  I sup- 
pose is  owing  to  the  pressure  of  the  water  on  the  larger  trunks 
of  the  blood-vessels  entering  the  cavity  being  more  intolerable 
than  on  the  smaller  ones;  for  if  the  larger  trunks  are  compress  - 
ed, it  must  inconvenience  the  branches  also;  but  if  some  of  the 
small  branches  are  compressed  only,  the  trunks  are  not  so  imme- 
diately incommoded. 

Blisters  on  the  head,  and  mercurial  ointment  externally,  with 
calomel  internally,  are  principally  recommended  in  this  fatal  dis- 
ease. When  the  patient  cannot  bear  to  be  raised  up  in  bed  with- 
out great  uneasiness,  it  is  a bad  symptom.  So  I believe  is  deaf- 
ness, which  is  commonly  mistaken  for  stupor.  See  Class  I.  2. 
5.  6.  And  when  the  dilatation  of  the  pupil  of  either  eye,  or  the 
squinting  is  very  apparent,  or  the  pupils  of  both  eyes  much  di- 


Class  I.  2.  3. 12. 


OF  IRRITATION. 


&7 


lated,  it  is  generally  fatal.  As  by  stimulating  one  branch  of 
lymphatics  into  inverted  motion,  another  branch  is  liable  to  ab- 
sorb its  fluid  more  hastily;  suppose  strong  errhines,  as  common 
tobacco  snuff  to  children,  or  one  grain  of  turpeth  mineral, 
(hydrargyrus  vitriolatus,)  mixed  with  ten  or  fifteen  grains  of  su- 
gar, were  gradually  blown  up  the  nostrils?  See  Class  I.  3.  2.  1. 
I have  tried  common  snuff  upon  two  children  in  this  disease; 
one  could  not  be  made  to  sneeze,  and  the  other  was  too  near  death 
to  receive  advantage.  When  the  mercurial  preparations  have 
produced  salivation,  I believe  they  may  have  been  of  service,  but 
I doubt  their  good  effect  otherwise.  In  one  child  I tried  the 
tincture  of  digitalis;  but  it  was  given  with  too  timid  a hand, 
and  too  late  in  the  disease,  to  determine  its  effects.  See  Sect. 
XXIX.  5.  9. 

As  all  the  above  remedies  generally  fail  of  success,  I think 
frequent,  almost  hourly,  shocks  of  electricity  from  very  small 
charges  might  be  passed  through  the  head  in  ail  directions  with 
probability  of  good  event;  as  by  Volta’s  rods  of  zinc  and  silver 
described  in  Class  I.  2.  5.  5.  A solution  of  hydrargyrus  muria- 
tus,  corrosive  sublimate  of  mercury  in  rectified  spirit  of  wine, 
three  grains  to  an  ounce,  is  said  to  produce  instantaneous  and 
violent  salivation;  as  described  in  Class  II.  1.  5.  1.  on  Gonor- 
rhoea. Could  a small  quantity  of  this  violent  stimulus  be 
used  according  to  the  age  of  the  child  with  probable  good  ef- 
fect? Could  the  trephine  be  used  with  safety  or  advantage 
where  the  affected  side  can  be  distinguished?  See  Strabismus, 
Class  I.  2.  5.  4.  When  one  eye  is  affected,  does  the  disease  ex- 
ist in  the  ventricle  of  that  side? 

The  following  extract  from  a letter  of  Dr.  Beddoes  on  hydro- 
cephalus internus,  is  well  worthy  to  be  attended  to. 

“ Master  L , aged  9 years,  became  suddenly  ill  in  the 

night  about  a week  before  I saw  him.  On  the  day  before  the 
attack,  he  had  taken  opening  medicines,  and  had  bathed  after- 
wards. He  had  complained  of  violently  acute  pain  in  his  head, 
shrieked  frequently,  ground  his  teeth  hard,  could  not  bear  to 
have  his  head  raised  from  the  pillow,  and  was  torpid  or 
deaf.  His  tongue  was  white,  pulse  110  in  the  evening  and  full. 
As  yet  the  pupil  of  the  eye  was  irritable,  and  he  had  no  strabis- 
mus. He  had  been  bled  with  leeches  about  the  head,  and  blister- 
ed. I directed  mercurial  inunction,  and  calomel  from  3 to  6 grains 
to  be  taken  at  first  every  six,  and  afterwards  every  three  hours. 
This  plan  produced  no  sensible  effect,  and  the  patient  died  on 
the  18th  day  after  the  seizure.  He  had  convulsion-fits  two  days 
preceding  his  death,  and  the  well-known  symptoms  of  hydro- 
cephalus internus  all  made  their  appearance.  From  what  I had 


88 


DISEASES 


Class  I.  2.  3.  13- 


seen  and  read  of  this  disease,  I believed  it  to  belong  to  inflamma- 
tions, and  at  an  earlier  period  I should  be  tempted  to  bleed  as 
largely  as  for  pneumonia.  The  fluid  found  after  death  in  the  ven- 
tricles of  the  brain  I impute  to  debility  of  the  absorbents  induc- 
ed by  inflammation.  My  reasons  are  briefly  these:  1.  The 
acuteness  of  the  pain.  2.  The  state  of  the  pulse.  In  the  above 
case  for  the  first  9 or  10  days  it  did  not  exceed  110,  and  was 
full  and  strong.  3.  To  find  out  whether  any  febrile  alternations 
took  place,  Master  L.’s  feet  were  frequently  felt,  and  they  were 
found  at  times  cold,  and  at  other  times  of  a dry  heat.  I have 
many  limes  seen  this  disease,  but  the  patients  were  too  young,  or 
too  far  advanced,  to  inform  me,  whether  they  had  chilness  suc- 
ceeded by  heat  at  its  onset.  4.  The  disorders  to  which  the 
young  are  more  peculiarly  liable  afford  a presumption,  that  hy- 
drocephalus internus  is  an  inflammatory  disease;  and  this  is 
confirmed  by  the  regularity  of  the  period,  within  which  it  finishes 
its  course.  And  lastly,  does  not  happen  more  frequently  than  is 
suspected  from  external  injury? 

“ I have  just  now  been  well  informed,  that  Dr.  Rush  has 
lately  cured  five  out  of  six  patients  by  copious  bleedings.  I 
relate  here  the  reasons  for  an  opinion  without  pretending  to  a 
discovery.  Something  like  this  doctrine  may  be  found  in  cer- 
tain modern  publications,  but  it  is  delivered  in  that  vague  and 
diffuse  style,  which  I trust  your  example  will  banish  from  medi- 
cal literature.” 

To  this  idea  of  Dr.  Beddoes  may  be  added,  that  the  hydrocele 
generally  succeeds  an  injury,  and  consequent  inflammation  of 
the  bag,  which  contains  it.  And  that  other  dropsies,  which 
principally  attend  inebriates,  are  consequent  to  too  great  action 
of  the  mucous  membranes  by  the  stimulus  of  beer,  wine,  and 
spirits.  And  lastly,  that  as  these  cases  of  hydrocephalus  end  so 
fatally,  a new  mode  of  treating  them  is  much  to  be  desired,  and 
deserves  to  be  seriously  attended  to. 

This  idea  of  inflammation  preceding  hydrocephalus  was  men- 
tioned by  Dr.  Quin,  and  afterwards  in  a pamphlet  of  Dr.  Pater- 
son of  Dublin. 

13.  Ascites.  The  dropsy  of  the  cavity  of  the  abdomen  is 
known  by  a tense  swelling  of  the  belly;  which  does  not  sound 
on  being  struck  like  the  tympany;  and  in  which  a fluctuation 
can  be  readily  perceived  by  applying  one  hand  expanded  on  one 
side,  and  striking  the  tumour  on  the  other. 

Effusions  of  water  into  large  cavities,  as  into  that  of  the  abdo- 
men or  thorax,  or  into  the  ventricles  of  the  brain  or  pericardi- 
um, are  more  difficult  to  be  reabsorbed,  than  the  effusion  of 
fluids  into  the  cellular  membrane;  because  one  part  of  this  ex- 


’l 


C lass  I,  2.  3.  14. 


OF  IRRITATION. 


89 


tensive  sponge-like  system  of  cells,  which  connects  all  the  solid 
parts  of  the  body,  may  have  its  power  of  absorption  impaired, 
at  the  same  time  that  some  other  part  of  it  may  still  retain  that 
power,  or  perhaps  possess  it  in  an  increased  degree;  and  as  all 
these  cells  communicate  with  each  other,  the  fluid,  which  abounds 
in  one  part  of  it,  can  be  transferred  to  another,  and  thus  be  re- 
absorbed into  the  circulation. 

In  the  ascites,  cream  of  tartar  has  sometimes  been  attended 
with  success;  a dram  or  two  drams  are  given  every  hour  in  a 
morning  till  it  operates,  and  this  is  to  be  repeated  for  several 
days;  but  the  operation  of  tapping  is  generally  applied  to  at  last. 
Dr.  Sims,  in  the  Memoirs  of  the  Medical  Society  of  London, 
Vol.  III.  has  lately  proposed,  what  he  believes  to  be  a more  suc- 
cessful method  of  performing  this  operation,  by  making  a punc- 
ture with  a lancet  in  the  scar  of  the  navel,  and  leaving  it  to  dis- 
charge itself  gradually  for  several  days,  without  introducing  a 
canula,  which  he  thinks  injurious,  both  on  account  of  the  too 
sudden  emission  of  the  fluid,  and  the  danger  of  wounding  or  stimu- 
lating the  viscera.  This  operation  I have  twice  known  per- 
formed with  less  inconvenience,  and  I believe  with  more  benefit 
to  the  patient,  than  the  common  method. 

After  the  patient  has  been  tapped,  some  have  tried  injections 
into  the  cavity  of  the  abdomen  but  hitherto  I believe  with  ill 
event.  Nor  are  experiments  of  this  kind  very  promising  of  suc- 
cess. First,  because  the  patients  are  generally  much  debilitated, 
most  frequently  by  spirituous  potation,  and  have  generally  a dis- 
ease of  the  liver,  or  of  other  viscera.  And  secondly,  because  the 
quantity  of  inflammation,  necessary  to  prevent  future  secretion  of 
mucus  into  the  cavity  of  the  abdomen,  by  uniting  the  peritoneum 
with  the  intestines  or  mesentery,  as  happens  in  the  cure  of  the 
hydrocele,  would,  I suppose,  generally  destroy  the  patient,  either 
immediately,  or  by  the  consequence  of  such  adhesions. 

This  however  is  not  the  case  in  respect  to  the  dropsy  of  the 
ovarium,  or  in  the  hydrocele. 

14.  Hydrops  thoracis.  The  dropsy  of  the  chest  commences 
with  loss  of  flesh,  cold  extremities,  pale  countenance,  high  co- 
loured urine  in  small  quantity,  and  general  debility,  like  many 
other  dropsies.  The  patient  next  complains  of  numbness  in  the 
arms,  especially  when  elevated,  with  pain  and  difficulty  of  swal- 
lowing, and  an  absolute  impossibility  of  lying  down  for  a few 
minutes,  or  with  sudden  starting  from  sleep,  with  great  difficulty 
of  breathing  and  palpitation  of  his  heart.  It  is  often  confounded 
with  anasarca  pulmonem,  which  see. 

The  numbness  of  the  arms  is  probably  owing  more  frequently  to 
the  increased  action  of  the  pectoral  muscles  in  respiration, 

VOL.  II.  n 


90 


DISEASES 


Class.  I.  2.  S.  14. 


whence  they  are  less  at  liberty  to  perform  other  offices,  than  to 
the  connexion  of  nerves  mentioned  in  Sect.  XXIX.  5.  2.  The 
difficulty  of  swallowing  is  owing  to  the  compression  of  the 
oesophagus  by  the  lymph  in  the  chest;  and  the  impossibility  of 
breathing  in  a horizontal  posture  originates  from  this,  that  if  any 
parts  of  the  lungs  must  be  rendered  useless,  the  inability  of  the 
extremities  of  them  must  be  less  inconvenient  to  respiration; 
since  if  the  upper  parts  or  larger  trunks  of  the  air-vessels  should 
be  rendered  useless  by  the  compression  of  the  accumulated  lymph, 
the  air  could  not  gain  admittance  to  the  other  parts,  and  the  ani- 
mal must  immediately  perish. 

If  the  pericardium  is  the  principal  seat  of  the  disease,  the 
pulse  is  quick  and  irregular.  If  only  the  cavity  of  the  thorax  is 
hydropic,  the  pulse  is  not  quick  nor  irregular. 

If  one  side  is  more  affected  than  the  other,  the  patient  leans 
most  that  way,  and  has  more  numbness  in  that  arm. 

The  hydrops  thoracis  is  distinguished  from  the  anasarca  pul- 
monum,  as  the  patient  in  the  former  cannot  lie  down  half  a mi- 
nute; in  the  latter  the  difficulty  of  breathing,  which  occasions 
him  to  rise  up,  comes  on  more  gradually;  as  the  transition  of 
the  lymph  in  the  cellular  membrane  from  one  part  to  another  of 
it  is  slower,  than  that  of  the  effused  lymph  in  the  cavity  of  the 
chest. 

The  hydrops  thoracis  is  often  complicated  with  fits  of  con- 
vulsive breathing;  and  then  it  produces  a disease  for  the  time 
very  similar  to  the  common  periodic  asthma,  which  is  perhaps 
owing  to  a temporary  anasarca  of  the  lungs;  or  to  an  impaired 
venous  absorption  in  them.  These  exacerbations  of  difficult 
breathing  are  attended  with  cold  extremities,  cold  breath,  cold 
tongue,  upright  posture  with  the  mouth  open,  and  a desire  of 
cold  air,  and  a quick,  weak,  intermittent  pulse,  and  contracted 
hands. 

These  exacerbations  recur  sometimes  every  two  or  three  hours, 
and  are  relieved  by  opium,  a grain  every  hour  for  two  or  three 
doses,  with  ether  about  a dram  in  cold  water;  and  seem  to  be  a 
convulsion  of  the  muscles  of  respiration  induced  by  the  pain  of 
the  dyspnoea.  As  in  Class  III.  1.  1.  9. 

M.  M.  A grain  of  dried  squill,  and  a quarter  of  a grain  of 
blue  vitriol  every  hour  for  six  or  eight  hours,  unless  it  vomit  or 
purge.  A grain  of  opium.  Blisters.  Calomel  three  grains  every 
third  day,  with  infusion  of  senna.  Bark.  Chalybeates.  Punc- 
ture in  the  side. 

Can  the  fluctuation  in  the  chest  be  heard  by  applying  the  ear 
to  the  side,  as  Hippocrates  asserts?  Can  it  be  felt  by  the  hand  or 
by  the  patient  before  the  disease  is  too  great  to  admit  of  cure  by 


Class  I.  2.  3.  15. 


OF  IRRITATION-. 


91 


the  paracentesis?  Does  this  dropsy  of  the  chest  often  come  on 
after  peripneumony?  Is  it  ever  cured  by  making  the  patient  sick 
by  tincture  of  digitalis?  Could  it  be  cured,  if  on  one  side  only, 
by  the  operation  of  puncture  between  the  ribs,  and  afterwards 
by  inflaming  the  cavity  by  the  admission  of  air  for  a time,  like 
the  cure  of  the  hydrocele;  the  pleura  afterwards  adhering  wholly 
to  that  lobe  of  the  lungs,  so  as  to  prevent  any  future  effusion  of 
mucus? 

I suspect  the  anasarca  of  the  lungs,  as  well  as  the  hydrops 
thoracis,  to  be  most  frequently  a disease  of  those  membranes  only, 
and  not  to  depend  on  the  general  paralysis  of  the  absorbent 
system;  and  that  they  are  then  not  accompanied  with  swelled 
legs,  till  the  patient  becomes  universally  weak;  and  that  they 
have  for  their  cause  a rheumatic  or  gouty  peripneumony  or  pleu- 
risy; that  is,  that  the  lungs  or  pleura  have  been  inflamed  from 
their  sympathy  with  some  other  viscus,  and  have  deposited  much 
coagulable  lymph  on  the  surface  of  their  inflamed  membranes, 
which  could  not  readily  become  absorbed,  and  has  thus  caused 
the  dropsy  of  the  cavity  of  the  chest,  like  the  coagulable  lymph 
or  chalky  matter  left  after  the  gout  and  rheumatism  in  other 
parts;  or  that  the  cellular  membrane  of  the  lungs  becomes  filled 
with  a fluid  from  the  present  inaction  of  their  absorbent  ves- 
sels, which  had  previously  been  excited  too  violently;  and  that 
the  anasarca  of  the  lungs  is  thus  produced  like  the  anasarca 
which,  frequently  in  weak  constitutions,  exists  after  the  gout  in 
the  feet  and  knees,  and  after  rheumatic  inflammations  of  the 
joints.  See  Peripneumonia,  Class  II.  1.  2.  4.  whence  it  appears, 
why  the  hydrops  thoracis  and  anasarca  pulmonum  so  generally 
occur  in  gouty  constitutions. 

15.  Hydrops  ovarii.  Dropsy  of  the  ovary  is  another  encysted 
dropsy,  which  seldom  admits  of  cure.  It  is  distinguished  from 
ascites  by  the  tumour  and  pain,  especially  at  the  beginning, 
occupying  one  side,  and  the  fluctuation  being  less  distinctly  per- 
ceptible. When  it  happens  to  young  subjects  it  is  less  liable  to 
be  mistaken  for  ascites.  It  affects  women  of  all  ages,  either 
married  or  virgins;  and  is  produced  by  cold,  fear,  hunger,  bad 
food,  and  other  debilitating  causes.  I saw  an  elegant  young  lady, 
who  was  shortly  to  have  been  married  to  a sensible  man,  with 
great  prospect  of  happiness;  who,  on  being  overturned  in  a 
chaise  in  the  night,  and  obliged  to  walk  two  or  three  miles  in 
wet,  cold,  and  darkness,  became  much  indisposed,  and  gradually 
afflicted  with  a swelling  and  pain  on  one  side  of  the  abdomen; 
which  terminated  in  a dropsy  of  the  ovary,  and  destroyed  her  in 
two  or  three  years.  Another  young  woman  I recollect  seeing, 
who  was  about  seventeen,  and  being  of  the  very  inferior  class 


92 


DISEASES 


Class  I.  2.  3.  16, 


of  people,  seemed  to  have  been  much  weakened  by  the  hardship 
of  a cold  floor,  and  little  or  no  bed,  with  bad  food;  and  who  to 
these  evils  had  to  bear  the  unceasing  obloquy  of  her  neighbours, 
and  the  persecution  of  parish  officers. 

The  following  is  abstracted  from  a letter  of  my  friend  Mr. 
Power,  surgeon,  at  Bosworth  in  Leicestershire,  on  examining  the 
body  of  an  elderly  lady  who  died  of  this  disease,  March  29, 
1793.  “ On  opening  the  abdomen  I found  a large  cyst  attached 

to  the  left  ovarium  by  an  elastic  neck  as  thick  as  the  little  fin- 
ger, and  so  callous  as  not  to  admit  of  being  separated  by  scissars 
without  considerable  difficulty.  The  substance  of  the  cyst  had 
an  appearance  much  resembling  the  gravid  uterus  near  the  full 
period  of  gestation,  and  was  as  thick.  It  had  no  attachment  to 
the  peritoneum,  or  any  of  the  viscera,  except  by  the  hard  callous 
neck  I have  mentioned;  so  that  the  blood  must  with  difficulty 
have  been  circulated  through  it  for  some  time.  Its  texture  was 
extremely  tender,  being  easily  perforated  with  the  finger,  was  of 
a livid  red  colour,  and  evidently  in  a sphacelated  state.  It  con- 
tained about  two  gallons  of  a fluid  of  the  colour  of  port  wine, 
without  any  greater  tenacity.  It  has  fallen  to  my  lot  to  have 
opened  two  other  patients,  whose  deaths  Avere  occasioned  by  en- 
cysted dropsy  of  the  ovarium.  In  one  of  these  the  ovarium  was 
much  enlarged  with  eight  or  ten  cysts  on  its  surface,  but  there 
was  no  adhesion  formed  by  any  of  the  cysts  to  any  other  part; 
nor  had  the  ovarium  formed  any  adhesion  with  the  peritoneum, 
though  in  a very  diseased  state.  In  the  other  the  disease  rvas 
more  simple,  being  only  one  cyst;  without  any  attachment  but 
to  the  ovarium. 

“ As  the  ovarium  is  a part  not  necessary  to  life,  and  dropsies 
of  this  kind  are  so  generally  fatal  in  the  end,  I think  I shall  be 
induced,  notwithstanding  the  hazard  attending  Avounds,  Avhich 
penetrate  the  cavity  of  the  abdomen,  to  propose  the  extirpation 
of  the  diseased  part  in  the  first  case,  which  occurs  to  me,  in 
which  I can  Avith  precision  say,  that  the  ovarium  is  the  seat  of 
the  disease,  and  the  patient  in  other  respects  tolerably  healthy; 
as  the  cavity  of  the  abdomen  is  often  opened  in  other  cases 
without  bad  consequences.” 

An  argument,  which  might  further  countenance  the  opera- 
tion thus  proposed  by  Mr.  PoAver  might  be  taken  from  the  dis- 
ease frequently  affecting  young  persons;  from  its  being  gene- 
rally in  these  subjects  local  and  primary;  and  not  like  the  ascites 
produced  or  accompanied  with  other  diseased  vuscera;  and  last- 
ly, as  it  is  performed  in  adult  quadrupeds,  as  old  soavs,  with 
safety,  though  by  aAvkAvard  operators. 

16.  vinasarca  pulmonum.  The  dropsy  of  the  cellular  mem- 


Class  I.  2.  3.  16. 


OF  IRRITATION'. 


93 


brane  of  the  lungs  is  usually  connected  with  that  of  the  other 
parts  of  the  system.  As  the  cells  of  the  whole  cellular  mem- 
brane communicate  with  each  other,  the  mucilaginous  fluid, 
which  remains  in  any  part  of  it  for  want  of  due  absorption,  sinks 
down  to  the  most  depending  cells;  hence  the  legs  swell,  though 
the  cause  of  the  disease,  the  deficiency  of  absorption,  may  be  in 
other  parts  of  the  system.  The  lungs  however  are  an  exception 
to  this,  since  they  are  suspended  in  the  cavity  of  the  thorax,  and 
have  in  consequence  a depending  part  of  their  own. 

The  anasarca  of  the  lungs  is  known  by  the  difficulty  of  respi- 
ration accompanied  with  swelled  legs,  and  with  a very  irregu- 
lar pulse.  This  last  circumstance  has  generally  been  ascribed 
to  a dropsy  at  the  same  time  existing  in  the  pericardium,  but  is 
more  probably  owing  to  the  difficult  passage  of  the  blood  through 
the  lungs;  because  I found  on  dissection,  in  one  instance,  that 
the  most  irregular  pulse,  which  I ever  attended  to,  was  owing  to 
very  extensive  adhesion  of  the  lungs;  insomuch  that  one  lobe  in- 
tirely  adhered  to  the  pleura;  and  secondly,  because  this  kind  of 
dropsy  of  the  lungs  is  so  certainly  removed  for  a time  along  with 
the  anasarca  of  the  limbs  by  the  use  of  digitalis. 

This  medicine,  as  well  as  emetic  tartar,  or  squill,  when  given 
so  as  to  produce  sickness,  or  nausea,  or  perhaps  even  without 
producing  either  in  any  perceptible  degree,  by  affecting  the  lym- 
phatics of  the  stomach,  so  as  either  to  invert  their  motion,  or  to 
weaken  them,  increases  by  reverse  sympathy  the  action,  and  con- 
sequent absorbent  power  of  these  lymphatics,  which  open  into 
the  cellular  membrane.  But  as  these  medicines  seldom  succeed 
in  producing  an  absorption  of  those  fluids,  which  stagnate  in  the 
larger  cavities  of  the  body,  as  in  the  abdomen,  or  chest,  and  do 
generally  succeed  in  this  difficulty  of  breathing  with  irregular 
pulse  above  described.  I conclude  that  it  is  not  owing  to  an  effu- 
sion of  lymph  into  the  pericardium,  but  simply  to  an  anasarca 
of  the  lungs. 

M.  M.  Digitalis.  See  Art.  V.  2.  1.  2.  and  IV.  2.  3.  7. 
Tobacco.  Squill.  Emetic  tartar  (antimonium  tartarizatum.) 
Then  Sorbentia.  Chalybeates.  Opium  half  a grain  twice  a 
day.  Raisin  wine  and  water,  or  other  wine  and  water,  is  pre- 
ferred to  the  spirit  and  water,  which  these  patients  have  gene- 
rally been  accustomed  to. 

I have  seen  two  cases,  which  were  esteemed  to  be  hydrotho- 
rax, but  which  I believed  to  be  anasarca  pulmonum,  though  they 
were  attended  with  irregular  pulse;  for  I do  not  understand, 
why  an  irregularity  of  pulse  should  be  occasioned  by  water  in 
the  pericardium  any  more  than  by  water  in  the  lungs,  or  by 


94 


DISEASES 


Class  I.  2.  3.  17. 


any  other  obstruction  to  the  circulation.  See  Class  IV.  2.  1 
18.  Pulsus  intermittens,  and  Palpitatio  cordis. 

In  both  these  cases  the  patients  couid  not  sleep  above  one  mi- 
nute at  a time;  which  I ascribed  to  the  debility  of  the  action  of 
the  heart  compared  with  the  resistance  to  the  circulation,  and 
that  some  voluntary  exertion  became  necessary  to  carry  on  the 
circulation,  which  does  not  exist  in  sleep.  See  Class  I.  2.  1.  3. 
Somntts  interruptus. 

These  two  cases  of  patients  about  sixty  years  of  age  are  here 
mentioned  from  a curious  circumstance,  that  both  the  patients 
became  in  some  degree  insane  after  being  relieved  by  the  tinc- 
ture of  digitalis  taken  to  the  quantity  of  thirty  drops  three  or  four 
times  a day  for  two  or  three  hays;  and  remained  in  a slight  de- 
gree of  insanity  for  some  months,  and  then  as  this  increase  of 
voluntary  exertion  ceased,  they  again  became  afflicted  with  the 
anasarca  pulmonum,  and  swelling  of  die  legs,  and  this  repeat- 
edly for  two  or  three  years.  1 have  before  seen  a common  ana- 
sarca repeatedly  cured  by  insanity  for  a year  or  two;  and  two 
fevers  I have  seen  attended  with  great  debility  cured  by  the  ac- 
cess of  insanity,  which  was  called  delirium  by  the  attendants; 
and  I lately  witnessed  the  present  cure  of  what  was  believed  to 
be  consumption  by  the  access  of  insanity.  All  which  were  pro- 
bably effected  by  the  increased  energy  of  some  parts  of  the  system 
owing  to  the  addition  of  volition  to  the  sensorial  powers  of  irrita- 
tion or  association. 

The  usual  cause  of  anasarca  is  from  a diseased  liver,  and 
hence  it  most  frequently  attends  those,  who  have  drunk  much 
fermented  or  spirituous  liquors;  but  I suspect  that  there  is  ano- 
ther cause  of  anasarca,  which  originates  from  the  brain;  and 
which  is  more  certainly  fatal  than  that,  which  originates  from  a 
diseased  liver.  These  patients,  where  the  anasarca  originates 
from,  or  commences  in,  the  brain,  have  not  other  symptoms  of 
diseased  liver;  have  less  difficulty  of  breathing  at  the  beginning; 
and  hold  themselves  more  upright  in  their  chair,  and  in  walking. 
In  this  kind  of  dropsy  I suspect  the  digitalis  has  less  or  no  effect; 
as  it  particularly  increases  the  absorption  from  the  lungs. 

17.  Obesitas.  Corpulency  may  be  called  anasarca  or  dropsy 
of  fat,  since  it  must  be  owing  to  an  analogous  cause;  that  is,  to 
the  deficient  absorption  of  fat  compared  to  the  quantity  secreted 
into  the  cells  which  contain  it.  See  Class  II.  1.  1.  4. 

The  method  of  getting  free  from  too  much  fat  without  any  in- 
jury to  the  constitution,  consists  first,  in  putting  on  a proper  ban- 
dage on  the  belly,  so  that  it  can  be  tightened  or  relaxed  with  ease 
as  a lightish  under  waistcoat,  with  a double  row  of  buttons. 
This  is  to  compress  the  bowels  and  increase  their  absorption : 


Ci. ass  I.  2.  3.  18. 


OP  IRRITATION. 


95 


and  it  thus  removes  one  principal  cause  of  corpulency,  which  is 
the  looseness  of  the  skin.  Secondly,  he  should  omit  one  entire 
meal,  as  supper;  by  this  long  abstinence  from  food  the  absorbent 
system  will  act  on  the  mucus  and  fat  with  greater  energy. 
Thirdly,  he  should  drink  as  little  as  he  can  with  ease  to  his  sen- 
sations; since,  if  the  absorbents  of  the  stomach  and  bowels  sup- 
ply the  blood  with  much,  or  perhaps  too  much,  aqueous  fluid, 
the  absorbents  of  the  cellular  membrane  will  act  with  less  energy. 
Fourthly,  he  should  use  much  salt  or  salted  meat,  which  will 
increase  the  perspiration  and  make  him  thirsty;  and  if  he  bears 
this  thirst,  the  absorption  of  his  fat  will  be  greatly  increased,  as 
appears  in  fevers  and  dropsies  with  thirst;  this  I believe  to  be 
more  efficacious  than  soap.  Fifthly,  he  may  use  aerated  alka- 
line water  for  his  drink,  which  may  be  supposed  to  render  the 
fat  more  fluid, — or  he  may  take  soap  in  large  quantities,  which 
will  be  decomposed  in  the  stomach.  Sixthly,  short  rest,  and 
constant  exercise. 

Vinegar  has  been  said  to  reduce  corpulency,  but  as  it  contains 
much  vinous  spirit,  it  may  injure  the  general  health  without  pre- 
viously inducing  leanness.  Perhaps  crystals  of  tartar  might  suc- 
ceed better  used  daily  in  water  at  meals. 

The  most  efficacious  method  of  reducing  the  quantity  of  the 
fat  I suspect  may  be  by  the  use  of  the  tincture  of  digitalis  in  small 
quantity,  as  twenty  or  thirty  drops  twice  a day,  as  directed  in 
Article  IV.  2.  3.  7.  As  the  effect  of  this  medicine,  when  given 
in  greater  quantity,  as  in  forty  drops  twice  or  thrice  a day  in  hy- 
drothorax or  general  anasarca,  evidently  consists  in  weakening 
the  natural  actions  of  the  stomach,  perhaps  by  previously  stimu- 
lating that  viscus  too  violently;  in  consequence  the  heart  and 
arteries  act  less  powerfully  from  their  sympathy  with  the  stomach; 
and  the  capillary  vessels,  and  absorbents,  act  more  powerfully  in 
consequence  of  the  less  expenditure  of  sensorial  power  by  the 
inert  action  of  the  heart  and  arteries;  and  will  consequently  ab- 
sorb the  accumulated  fat  from  the  cellular  membrane,  as  explain- 
ed in  Supplement!.  12.  10. 

18.  Splenis  tumor.  Swellings  of  the  spleen,  or  in  its  vicinity, 
are  frequently  perceived  by  the  hand  in  inlermittents,  which  are 
called  Ague-cakes,  and  seem  owing  to  a deficiency  of  absorption 
in  the  affected  part. 

Mr.  Y , a young  man  about  tv>Tenty-five  years  of  age, 

who  lived  intemperately,  was  seized  with  an  obstinate  intermit- 
tent, which  had  become  a continued  fever  with  strong  pulse,  at- 
tended with  daily  remission.  A large  hard  tumour  on  the  left 
side,  on  the  region  of  the  spleen,  but  extending  much  more 
downward,  was  so  distinctly  perceptible,  that  one  seemed  to  get 


96 


DISEASES 


Class  I.  2.  3.  19. 


one’s  fingers  under  the  edge  of  it,  much  like  the  feel  of  the  brawn 
or  shield  on  a boar’s  shoulder.  He  was  repeatedly  bled,  and  purg- 
ed with  calomel,  had  an  emetic,  and  a blister  on  the  part,  with- 
out diminishing  the  tumour;  after  some  time  he  took  the  Peru- 
vian bark,  and  slight  doses  of  chalybeates,  and  thus  became  free 
from  the  fever,  and  went  to  Bath  for  several  weeks,  but  the 
tumour  remained.  This  tumour  I examined  every  four  or  five 
years  for  above  thirty  years.  His  countenance  was  pale,  and 
towards  the  end  of  his  life  he  suffered  much  from  ulcers  on  his 
legs,  and  died  about  sixty,  of  general  debility;  like  many  others 
who  live  intemperately  in  respect  to  the  ingurgitation  of  ferment- 
ed or  spirituous  liquors. 

As  this  tumour  commenced  in  the  cold  fit  of  an  intermittent 
fever,  and  was  not  attended  with  pain,  and  continued  so  long 
without  endangering  his  life,  there  is  reason  to  believe  it  was 
simply  occasioned  by  deficient  absorption,  and  not  by  more  ener- 
getic action  of  the  vessels  which  constitute  the  spleen.  See 
Class  II.  1.  2.  13. 

M.  M.  Venesection.  Emetic,  cathartic  with  calomel;  then 
sorbentia,  chalybeates,  Peruvian  bark. 

19.  Genu  tumor  albus.  White  swelling  of  the  knee,  is  owing 
to  deficient  absorption  of  the  lymphatics  of  the  membranes  includ- 
ing the  joint,  or  capsular  ligaments,  and  sometimes  perhaps  of  the 
gland  which  secretes  the  synovia;  and  the  ends  of  the  bones  are 
probably  affected  in  consequence. 

I saw  an  instance,  where  a caustic  had  been  applied  by  an  em- 
pyric  on  a large  white  swelling  of  the  knee,  and  was  told,  that  a 
fluid  had  been  discharged  from  the  joint,  which  became  auchy- 
losed,  and  healed  without  loss  of  the  limb. 

M.  M.  Repeated  blisters  on  the  part  early  in  the  disease  are 
said  to  cure  it  by  promoting  absorption;  saturnine  solutions  ex- 
ternally are  recommended.  Bark,  animal  charcoal,  as  burnt 
sponge,  opium  in  small  doses.  Friction  with  the  hand.  Four 
or  six  leeches  applied  on  or  beneath  the  knee  alternately  with  the 
blisters,  and  a cupping  glass  put  over  the  wounds  made  by  the 
leeches  are  much  recommended. 

20.  Bronchocele.  Swelled  throat.  An  enlargement  of  the 
thyroid  glands,  said  to  be  frequent  in  mountainous  countries, 
where  river  water  is  drunk,  which  has  its  source  from  dissolving 
snows.  This  idea  is  a very  ancient  one,  but  perhaps  not  on 
that  account  to  be  the  more  depended  upon,  as  authors  copy 
one  another.  Tumidum  guttur  quis  miratur  in  Alpibus,  seems 
to  have  been  a proverb  in  the  time  of  Juvenal.  The  inferior 
people  of  Derby  are  much  subject  to  this  disease,  but  whether 
more  so  than  other  populous  towns,  I cannot  determine;  certain 


Class  I.  2.  3.  21. 


OF  IRRITATION. 


97 


it  is,  that  they  chiefly  drink  the  water  of  the  Derwent,  which 
arises  in  a mountainous  country,  and  is  very  frequently  blacken- 
ed as  it  passes  through  the  morasses  near  its  source;  and  is  gen- 
erally of  a darker  colour,  and  attended  with  a whiter  foam,  than 
the  Trent,  into  which  it  falls;  the  greater  quantity  and  white- 
ness of  its  froth  I suppose  may  be  owing  to  the  viscidity  com- 
municated to  it  by  the  colouring  matter.  The  lower  parts  of 
the  town  of  Derby  might  be  easily  supplied  with  spring  water 
from  St.  Alkmond’s  well;  or  the  whole  of  it  from  the  abun- 
dant springs  near  Bovvbridge;  the  water  from  which  might  be 
conveyed  to  town  in  hollow  bricks,  or  clay-pipes,  at  no  very 
great  expence,  and  might  be  received  into  frequent  reservoirs 
with  pumps  to  them;  or  laid  into  the  houses. 

M.  M.  Twenty  grains  of  burnt  sponge  with  ten  of  nitre  made 
with  mucilage  into  lozenges,  and  permitted  to  dissolve  slowly  un- 
der the  tongue  twice  a day,  is  asserted  to  cure  in  a few  months; 
perhaps  other  animal  charcoal,  as  candle-snuffs,  might  do  the 
same. 

I have  directed  in  the  early  state  of  this  disease  a mixture  of 
common  salt  and  water  to  be  held  in  the  mouth,  particularly 
under  the  tongue,  for  a few  minutes,  four  or  six  times  a day  for 
many  weeks,  which  has  sometimes  succeeded;  the  salt  and  water 
is  then  spit  out  again,  or  in  part  swallowed.  Externally  vinegar 
of  squills  has  been  applied,  or  a mercurial  plaster,  or  fomentations 
of  acetated  ammoniac;  or  other.  Some  empyrics  have  applied 
caustics  on  the  bronchocele,  and  sometimes,  I have  been  told, 
with  success;  which  should  certainly  be  used  where  there  is 
danger  of  suffocation  from  the  bulk  of  it.  One  case  I saw,  and 
one  I was  well  informed  of,  where  the  bronchocele  was  cured  by 
burnt  sponge,  and  a hectic  fever  supervened  with  colliquative 
sweats;  but  I do  not  know  the  final  event  of  either  of  them. 

De  Haen  affirms  the  cure  of  bronchocele  to  be  effected  by 
flowers  of  zinc,  calcined  egg-shells,  and  scarlet-cloth  burnt  to- 
gether in  a close  crucible,  which  was  tried  with  success,  as  he 
assured  me,  by  a late  lamented  physician,  my  friend,  Dr.  Small 
of  Birmingham;  who  to  the  cultivation  of  modern  sciences  add- 
ed the  integrity  of  ancient  manners;  who  in  clearness  of  head, 
and  benevolence  of  heart,  had  few  equals,  perhaps  no  superiors. 

21.  Scrofulus.  King’s  evil  is  known  by  tumours  of  the  lym- 
phatic glands,  particularly  of  the  neck.  The  upper  lip,  and  di- 
vision of  the  nostrils  are  swelled,  with  a florid  countenance,  a 
smooth  skin,  and  a tumid  abdomen.  Cullen.  The  absorbed 
fluids  in  their  course  to  the  veins  in  the  scrofula  are  arrested  in  the 
lymphatic  or  conglobate  glands;  which  swell,  and  after  a great 
length  of  time,  inflame  and  suppurate.  Materials  of  a peculiar 

VOL.  II.  e 


98 


DISEASES 


Class  I.  2.  3.  21. 


kind,  as  the  variolous  and  venereal  matter,  when  absorbed  in  a 
wound,  produce  this  torpor,  and  consequent  inflammation  of 
those  lymphatic  glands,  where  they  first  arrive,  as  in  the  axilla 
and  groin.  There  is  reason  to  suspect,  that  the  tonsils  frequent- 
ly become  inflamed,  and  suppurate  from  the  matter  absorbed 
from  carious  teeth  ; and  I saw  a young  lady,  who  had  both  the 
axillary  glands  swelled,  and  which  suppurated  ; which  was  be- 
lieved to  have  been  caused  by  her  wearing  a pair  of  new  green 
gloves  for  one  day,  when  she  had  perspired  much,  and  was  much 
exhausted  and  fatigued  by  walking  ; the  gloves  were  probably 
died  in  a solution  of  verditer. 

These  indolent  tumours  of  the  lymphatic  glands,  which  con- 
stitute the  scrofula,  originate  from  the  inirritability  of  those 
glands  ; which  therefore  sooner  fall  into  torpor  after  having 
been  stimulated  too  violently  by  some  poisonous  material;  as 
the  muscles  of  enfeebled  people  sooner  become  fatigued,  and 
cease  to  act,  when  exerted,  than  those  of  stronger  ones.  On  the 
same  account  these  scrofulus  glands  are  much  longer  in  acquir- 
ing increase  of  motion,  after  having  been  stimulated  into  in- 
activity, and  either  remain  years  in  a state  of  indolence,  or  sup- 
purate with  difficulty,  and  sometimes  only  partially. 

The  difference  between  scrofulus  tumours,  and  those  before 
described,  consists  in  this;  that  in  those,  either  glands  of  differ- 
ent kinds  were  diseased,  or  the  mouths  only  of  the  lymphatic 
glands  were  become  torpid;  whereas  in  scrofula  the  conglobate 
glands  themselves  become  tumid,  and  generally  suppurate  after 
a great  length  of  time,  when  they  acquire  new  sensibility. 
See  Sect.  XXXIX.  4.  5. 

These  indolent  tumours  may  be  brought  to  suppurate  some- 
times by  passing  electric  shocks  through  them  every  day  for  two 
or  three  weeks,  as  I have  witnessed.  It  is  probable,  that  the  al- 
ternate application  of  snow  or  iced  water  to  them,  till  they  be- 
come painfully  cold,  and  then  of  warm  flannel  or  warm  water,, 
frequently  repeated,  might  restore  their  irritability  by  accummula- 
tion  of  sensorial  power;  and  thence  either  facilitate  their  disper- 
sion, or  occasion  them  to  suppurate.  See  Class  II.  1.  4.  13. 

This  disease  is  very  frequent  amongst  the  children  of  the  poor 
in  large  towns,  who  are  in  general  ill  fed,  ill  lodged,  and  ill  cloth- 
ed; and  who  are  further  weakened  by  eating  much  salt  with 
their  scanty  meal  of  insipid  vegetable  food,  which  is  seldom  of 
better  quality  than  water  gruel,  with  a little  coarse  bread  in  it. 
See  diarrhoea  of  infants,  Class  I.  1.  2.  5.  Scrofulus  ulcers  are 
difficult  to  heal,  which  is  owing  to  the  deficiency  of  absorption 
on  their  pale  and  flabby  surfaces,  and  to  the  general  inirritability 
of  the  system.  See  Class  I.  1.  3.  13, 


CiAss.  I.  2.  3.  22. 


OF  IRRITATION. 


89 


M.  M.  Plentiful  diet  of  flesh  meat  and  vegetables  with  small 
beer.  Opium,  from  a quarter  of  a grain  to  half  a grain  twice 
a day.  Sorbentia.  Tincture  of  digitalis,  thirty  drops  twice  a 
day.  Externally  sea-bathing,  or  bathing  in  salt  and  water,  one 
pound  to  three  gallons  made  warm.  The  application  of  Peru- 
vian bark  in  fine  powder,  seven  parts,  and  white-lead  (cerussa,) 
in  fine  pow'der  one  part,  mixed  together,  and  applied  on  the  ul- 
cers in  dry  powder,  by  means  of  lint  and  a bandage,  to  be  renew- 
ed every  day.  Or  very  fine  powder  of  calamy  alone,  lapis  ca- 
laminaris.  If  powder  of  manganese?  See  Class  II.  1.  4.  13. 

22.  Scirrhus.  After  the  absorbent  veins  of  a gland  cease  to 
perform  their  office,  if  the  secerning  arteries  of  it  continue  to 
act  some  time  longer,  the  fluids  are  pushed  forwards,  and  stag- 
nate in  the  receptacles  or  capillary  vessels  of  the  gland;  and  the 
thinner  part  of  them  only  being  resumed  by  the  absorbent  system 
of  the  gland,  a hard  tumour  gradually  succeeds;  w'hich  contin- 
ues like  a lifeless  mass,  till  from  some  accidental  violence  it  gains 
sensibility,  and  produces  cancer,  or  suppurates.  Of  this  kind 
are  the  scirrhus  glands  of  the  breasts,  of  the  lungs,  of  the  me- 
sentery, and  the  scrofulous  tumours  about  the  neck  and  the  bron- 
chocele. 

Another  seat  of  scirrhus  is  in  the  membranous  parts  of  the 
system,  as  of  the  rectum  intestinum,  the  urethra,  the  gula  or 
throat;  and  of  this  kind  is  the  veruca  or  wart,  and  the  clavus  pe- 
dum, or  corns  on  the  toes.  A wen  sometimes  arises  on  the  back 
of  the  neck,  and  sometimes  between  the  shoulders;  and  by  dis- 
tending the  tendinous  fascia  produces  great  and  perpetual  pain. 

M.  M.  Mercurial  ointment.  Cover  the  part  with  oiled  silk. 
Extirpation.  Electric  shocks  through  the  tumour.  An  issue 
into  the  substance  of  the  wen.  Opium.  Ether  externally. 

23.  Scirrhus  recti  inteslini.  Scirrhus  of  the  rectum.  A 

scirrhus  frequently  affects  a canal,  and  by  contracting  its  diame- 
ter becomes  a painful  and  deplorable  disease.  The  canals  thus 
obstructed  are  the  rectum,  the  urethra,  the  throat,  the  gall-ducts, 
and  probably  the  excretory  ducts  of  the  lymphatics,  and  of  other 
glands. 

The  scirrhug  of  the  rectum  is  known  by  the  patient  having 
pain  in  the  part,  and  being  only  able  to  part  with  liquid  feces, 
and  by  the  introduction  of  the  finger;  the  swelled  part  of  the 
intestine  is  sometimes  protruded  downwards,  and  hangs  like  a 
valve,  smooth  and  hard  to  the  touch,  with  an  aperture  in  the 
centre  of  it.  See  a paper  on  this  subject  by  J.  Sherwin.  Me- 
moirs of  a London  Medical  Society,  Vol.  II.  p.  9. 

M.  M.  To  take  but  little  solid  food.  Aperient  medicines. 


10U 


DISEASES 


Class  I.  2.  3.  24. 


Introduce  a candle  smeared  with  mercurial  ointment.  Sponge- 
tent.  Clysters  with  forty  drops  of  laudanum.  Introduce  a 
leathern  canula,  or  gut,  and  then  either  a wooden  maundril,  or 
blow  it  up  with  air,  so  as  to  distend  the  contracted  part  as  much 
as  the  patient  can  bear.  Or  spread  mercurial  plaster  on  thick 
soft  leather,  and  roll  it  up  with  the  plaster  outwards  to  any  thick- 
ness and  length,  which  can  be  easily  introduced  and  worn;  or 
two  or  three  such  pieces  may  be  introduced  after  each  other. 
The  same  may  be  used  to  compress  bleeding  internal  piles.  See 
Class  I.  2. 1.  6.  Rub  mercurial  ointment  on  the  sphincter  ani 
every  night  for  a fortnight. 

May  not  this  disease  be  cured  by  lunar  caustic  applied  on  the 
end  of  a pessary  or  bougie,  in  the  same  manner  as  used  by  J. 
Hunter,  and  since  by  Mr.  E.  Home,  in  strictures  of  the  urethra; 
when  on  introducing  the  finger,  a kind  of  membranous  valve 
can  be  distinguished  rather  than  an  extensive  scirrhus  or  indura- 
tion. See  the  next  article. 

24.  Scirrhus  urethm.  Scirrhus  of  the  urethra.  The  passage 
becomes  contracted  by  the  thickened  membrane,  and  the  urine  is 
forced  through  with  great  difficulty,  and  is  thence  liable  to  dis- 
tend the  canal  behind  the  stricture;  till  at  length  an  aperture  is 
made,  and  the  urine  forces  its  way  into  the  cellular  membrane, 
making  large  sinuses.  This  situation  sometimes  continues  many 
months,  or  even  years,  and  so  much  matter  is  evacuated  after 
making  water,  or  at  the  same  time,  by  the  action  of  the  muscles 
in  the  vicinity  of  the  sinuses,  that  it  has  been  mistaken  for  an  in- 
creased secretion  from  the  bladder,  and  has  been  erroneously 
termed  a catarrh  of  the  bladder.  See  a paper  by  Dr.  R.  W. 
Darwin  in  the  Medical  Memoirs. 

M.  M.  Distend  the  part  gradually  by  catgut  bougies,  which, 
by  their  compression,  will  at  the  same  time  diminish  the  thickness 
of  the  membrane,  or  by  bougies  of  elastic  gum,  or  of  horn  boil- 
ed soft.  The  patient  should  gain  the  habit  of  making  water 
slowly,  which  is  a matter  of  the  utmost  consequence,  as  it  pre- 
vents the  distention  and  consequent  rupture,  of  that  part  of  the 
urethra,  which  is  between  the  stricture  and  the  neck  of  the 
bladder. 

When  there  occurs  an  external  ulcer  in  the  perineum,  and 
the  urine  is  in  part  discharged  that  way,  the  disease  cannot  be 
mistaken.  Otherwise,  from  the  quantity  of  matter,  it  is  general- 
ly supposed  to  come  from  the  bladder,  or  prostate  gland;  and 
the  urine,  which  escapes  from  the  ruptured  urethra,  mines  its 
way  amongst  the  muscles  and  membranes,  and  the  patient  dies 
tabid^  owing  to  the  want  of  an  external  orifice  to  discharge  the 
matter.  See  Class  II.  1.  4.  11. 


Giass  I.  2.  3.  25. 


OF  IRRITATION. 


101 


Mr.  Home  has  published  a very  ingenious  and  useful  work, 
entitled  a Dissertation  on  Strictures  of  the  Urethra,  in  which 
he  has  recorded  many  cases  successfully  treated  by  lunar  caus- 
tic, inserted  in  the  end  of  a bougie,  and  applied  to  the  contracted 
part  of  the  urethra,  so  as  to  destroy  the  stricture. 

From  the  form  of  the  cavity  of  the  urethra,  taken  by  injecting 
wax  into  it,  there  appears  naturally  to  exist  a kind  of  valve  im- 
mediately behind  the  bulb  of  the  urethra,  which  when  the  penis 
is  erect,  shuts  up  the  orifice,  and  prevents,  the  regurgitation  of 
the  semen  into  the  bladder  during  the  action  of  the  accelerator 
muscles  in  the  act  of  its  expulsion;  and  this  natural  constriction 
or  valve  appears  generally  to  be  the  first  seat  of  stricture. 

Above  the  bulb,  about  two  or  three  inches  from  the  orifice 
cf  the  glans,  the  cavity  of  the  urethra  appears  also  lessened;  and 
in  some  cases  the  orifice  of  the  very  extremity  appears  less  than 
other  parts  of  the  canal;  these  parts  are  therefore  more  contract- 
ed during  the  emissio  seminis,  and  add  to  its  velocity  at  its  exit; 
and  are  thence  more  liable  to  scirrhosity  or  stricture.  And  by 
some  observations,  Mr.  Home  has  shewn,  that  a sympathy  exists 
between  the  strictures  of  these  parts;  and  that  the  more  forward 
strictures  are  frequently  produced  in  consequence  of  that  behind 
the  bulb;  and  finds  it  necessary  to  destroy  them  all,  by  frequent 
application  of  the  caustic. 

By  the  use  of  which,  (which  was  first  proposed  by  Wiseman, 
first  applied  by  John  Hunter,  and  so  greatly  improved  by  Mr. 
Home,)  the  lives  of  great  numbers  are  rendered  happy,  who  other- 
wise gradually  perish  by  a most  painful  and  hopeless  malady. 

25.  Scirrhus  cesophagi.  A scirrhus  of  the  throat  contracts  the 
passage  so  as  to  render  the  swallowing  of  solids  impracticable, 
and  of  liquids  difficult.  It  affects  patients  of  all  ages,  hut  is 
probably  most  frequently  produced  by  swallowing  hard  angular 
substances,  when  people  have  lost  their  teeth;  by  which  this 
membrane  is  over-distended,  or  torn,  or  otherwise  injured. 

M.  M.  Put  milk  into  a bladder  tied  to  a canula  or  catheter; 
introduce  it  past  the  stricture,  and  press  it  into  the  stomach. 
Distend  the  stricture  gradually  by  a sponge-tent  fastened  to  the 
end  of  a whalebone,  or  by  a plug  of  wax  or  spermaceti  candle, 
about  two  inches  long;  which  might  be  introduced,  and  left 
there  with  a string  only  fixed  to  it  to  hang  out  of  the  mouth,  to 
keep  it  in  its  place,  and  to  retract  it  by  occasionally;  for  which 
purpose  the  string  must  be  put  through  a catheter  or  hollow  pro- 
bang, when  it  is  to  be  retracted.  Or  lastly,  introduce  a gut 
fixed  to  a pipe;  and  then  distend  it  by  blowing  wind  into  it. 
The  swallowing  a bullet  with  a string  put  through  it,  to  retract 
it  on  the  exhibition  of  an  emetic  has  also  been  proposed.  Ex- 


102 


DISEASES 


Class  I.  2.  3.  25. 


ternally  mercurial  ointment  has  been  much  recommended. 
Poultice.  Oiled  silk.  Clysters  of  broth.  Warm  bath  of  broth 
Transfusion  of  blood  into  a vein  three  or  four  ounces  a day? 
See  Class  III.  1.  1.  15.  * 

I directed  a young  woman,  about  twenty-two  years  of  age, 
to  be  fed  with  new  milk  put  into  a bladder,  which  was  tied  to  a 
catheter,  and  introduced  beyond  the  stricture  in  her  throat;  af- 
ter a few  days  her  spirits  sunk,  and  she  refused  to  use  it  further, 
and  died.  Above  thirty  years  ago,  I proposed  to  an  old  gentle- 
man, whose  throat  was  entirely  impervious,  to  supply  him  with 
a few  ounces  of  blood  daily  from  an  ass,  or  from  the  human  ani- 
mal, who  is  still  more  patient  and  tractable,  in  the  following 
manner:  To  fix  a silver  pipe  about  an  inch  long  to  each  extremi- 
ty of  a chicken’s  gut,  the  part  between  the  two  silver  ends  to  be 
measured  by  filling  it  with  warm  water;  to  put  one  end  into  the 
vein  of  a person  hired  for  that  purpose,  so  as  to  receive  the 
blood  returning  from  the  extremity;  and  when  the  gut  was  quite 
full,  and  the  blood  running  through  the  other  silver  end,  to  intro- 
duce that  end  into  the  vein  of  the  patient  upwards  towards 
the  heart,  so  as  to  admit  no  air  along  with  the  blood.  And 
lastly,  to  support  the  gut  and  silver  ends  on  a water-plate,  fill- 
ed with  water  of  ninety-eight  degrees  of  heat,  and  to  measure 
how  many  ounces  of  blood  was  introduced  by  passing  the  finger, 
so  as  to  compress  the  gut,  from  the  receiving  pipe  to  the  deliver- 
ing-pipe; and  thence  to  determine  how  many  gut-fuls  were 
given  from  the  healthy  person  to  the  patient.  Mr. con- 

sidered a day  on  this  proposal,  and  then  another  day,  and  at 
length  answered,  that  “ he  now  found  himself  near  the  house  of 
death;  and  that,  if  he  could  return,  he  was  now  too  old  to  have 
much  enjoyment  of  life:  and  therefore  he  wished  rather  to  pro- 
ceed to  the  end  of  that  journey,  which  he  was  now  so  near,  and 
which  he  must  at  all  events  soon  go,  than  return  for  so  short  a 
time.”  He  lived  but  a ferv  days  afterwards,  and  seemed  quite 
careless  and  easy  about  the  matter.  See  Suppl.  I.  14.  4. 

A difficulty  of  swallowing  food,  and  a rejection  soon  after,  of 
the  whole  or  a part  of  it,  may  be  often  owing  probably  to  a sort 
of  valve  made  by  a part  of  the  membrane  which  lines  the  oesopha- 
gus; and  may  thus  resemble  strictures  of  the  urethra;  which 
last  are  so  frequently  cured  by  the  nice  application  of  lunar  caus- 
tic, as  described  by  Mr.  Everard  Home,  in  his  Treatise  on  Stric- 
tures of  the  Urethra.  Suppose  a thick  bougie,  made  of  linen 
spread  with  adhesive  plaster,  and  rolled  up,  was  armed  at  the 
end  with  a bit  of  lunar  caustic,  with  which  the  stricture  of  the 
oesophagus  could  be  touched  repeatedly,  till  an  unarmed  bougie 
could  be  passed  readily  into  the  stomach.  Could  such  a valve  be 


OP  IRRITATION. 


Class  I.  2.  3. 26, 


103 


burst,  or  inverted,  by  pouring  a pound  or  two  of  crude  mercury 
into  the  oesophagus? 

26.  Lacteorum  inirritabilitas.  Inirritability  of  the  lacteals  is 
described  in  Sect.  XXVIII.  under  the  name  of  paralysis  of  the 
lacteals;  but  as  the  word  paralysis  has  generally  been  applied  to 
the  disobedience  of  the  muscles  to  the  power  of  volition,  the- 
name  is  here  changed  to  inirritability  of  the  lacteals,  as  more 
characteristic  of  the  disease. 

27.  Lymphaticorum  inirritabilitas.  The  inirritability  of  the 
cellular  and  cutaneous  lymphatics  is  described  in  Sect.  XXIX.  5. 
1.  and  in  Class  I.  2.  3.  16.  The  inirritability  of  the  cutaneous 
lymphatics  generally  accompanies  anasarca,  and  is  the  cause  of 
the  great  thirst  in  that  malady.  At  the  same  time,  the  cellular 
lymphatics  act  with  greater  energy,  owing  to  the  greater  de- 
rivation of  sensorial  power  to  them,  in  consequence  of  the  less 
expenditure  of  it  by  the  cutaneous  ones;  and  hence  they  absorb 
the  fat,  and  mucus,  and  also  the  thinner  parts  of  the  urine. 
Whence  the  great  emaciation  of  the  body,  the  muddy  sediment, 
and  the  small  quantity  of  water  in  this  kind  of  dropsy. 


104 


DISEASES 


Glass  I.  2.  4. 


ORDO  II. 

Decreased  Irritation. 

GENUS  IV. 

With  decreased  Actions  of  other  Cavities  and  Membranes. 

Many  of  the  diseases  of  this  genus  are  attended  with  pain, 
and  with  cold  extremities,  both  which  cease  on  the  exhibition 
of  wine  or  opium  ; which  shows  that  they  originate  from  deficient 
action  of  the  affected  organ.  These  pains  are  called  nerv  ous  or 
spasmodic,  are  not  attended  with  fever,  but  are  frequently  suc- 
ceeded by  convulsions  and  madness;  both  which  belong  to  the 
class  of  volition.  Some  of  them  return  at  periods,  and  when 
these  can  be  ascertained,  a much  less  quantity  of  opium  will  pre- 
vent them,  than  is  necessary  to  cure  them,  when  they  are  begun; 
as  the  vessels  are  then  torpid  and  inirritable  from  the  want  of 
sensorial  power,  till  by  their  inaction  it  becomes  again  accumu- 
lated. 

Our  organs  of  sense,  properly  so  called,  are  not  liable  to  pain 
from  the  absence  of  their  appropriated  stimuli,  as  from  darkness 
or  silence;  but  the  other  senses,  which  may  be  more  properly 
called  appetites,  as  those  by  which  we  perceive  heat,  hunger, 
thirst,  lust,  want  of  fresh  air,  are  affected  with  pain  from  the  de- 
fect or  absence  of  their  accustomed  stimuli,  as  well  as  with  plea- 
sure by  the  possession  of  them;  it  is  probable  that  some  of  our 
glands,  the  sense  or  appetite  of  which  requires  or  receives  some- 
thing from  the  circulating  blood,  as  the  pancreas,  liver,  testes, 
prostate  gland,  may  be  affected  with  aching  or  pain,  when  they 
cannot  acquire  their  appropriate  fluid. 

Wherever  this  effect  of  stimulus  occurs,  a torpor  or  inaction 
of  the  organ  ensues,  as  in  the  capillaries  of  the  skin,  when  expos- 
ed to  cold;  and  in  the  glands,  which  secrete  the  gastric  juice, 
when  we  are  hungry.  This  torpor,  however,  and  concomitant 
pain,  which  are  at  first  owing  to  defect  of  stimulus,  are  after- 
wards induced  by  other  associations  or  catenations,  aud  consti- 
tute the  beginning  of  ague-fits. 

It  must  be  further  observed,  that  in  the  diseases  of  pain  with- 
out fever,  the  pain  is  frequently  not  felt  in  the  part  where  ihe 
cause  of  the  disease  resides;  but  is  induced  by  sympathy  with  a 
distant  part,  the  irritability  or  sensibility  of  which  is  greater  or 
less  than  its  own.  Thus  a stone  at  the  neck  of  the  bladder,  if  its 
stimulus  is  not  very  great,  only  induces  the  pain  of  strangury  at 


Glass  I.  2.  4. 1. 


OF  IRRITATION. 


105 


the  glans  penis.  If  its  stimulus  be  greater,  it  then  induces  pain 
at  the  neck  of  the  bladder.  The  concretions  of  bile,  which  are 
protruded  into  the  neck  of  the  gall-badder,  when  the  disease  is 
not  very  great,  produce  pain  at  the  other  extremity  of  the  bile- 
duct,  which  enters  the  duodenum  immediately  under  the  pit  of 
the  stomach;  but,  when  the  disease  is  great  from  the  largeness  of 
the  bile-stone,  the  pain  is  felt  in  the  region  of  the  liver  at  the 
neck  of  the  gall-bladder. 

It  appears  from  hence,  that  the  pains  enumerated  in  this  genus 
are  consequences  of  the  inactivity  of  the  organ;  and,  as  they  do 
not  occasion  other  diseases,  should  be  classed  according  to  their 
proximate  cause,  which  is,  defective  irritation;  there  are  never- 
theless other  pains  from  defect  of  stimulus,  which  produce  con- 
vulsions, and  belong  to  Class  III.  1.1.;  and  others,  which  pro- 
duce pains  of  some  distant  part  by  association,  and  belong  to 
Class  IV.  2.  2. 

SPECIES. 

1.  Sitis.  Thirst.  The  senses  of  thirst  and  of  hunger  seem 
to  have  this  connexion,  that  the  former  is  situated  at  the  upper 
end,  and  the  latter  at  the  lower  end  of  the  same  canal.  One 
about  the  pharinx,  where  the  oesophagus  opens  into  the  mouth, 
and  the  other  about  the  cardia  ventriculi,  where  it  opens  into  the 
stomach.  The  extremities  of  other  canals  have  been  shewn  to 
possess  correspondent  sensibilities,  or  irritabilities,  as  the  two  ends 
of  the  urethra,  and  of  the  common  gall-duct.  See  IV.  2.  2.  2. 
and  4. 

The  membrane  of  the  upper  end  of  the  gullet  becomes  torpid, 
and  consequently  painful,  when  there  is  a deficiency  of  aqueous 
fluid  in  the  general  system;  it  then  wants  its  proper  stimulus. 
In  the  same  manner  a want  of  the  stimulus  of  more  solid  mate- 
rials at  the  other  end  of  the  canal,  which  terminates  in  the  sto- 
mach, produces  hunger;  as  mentioned  in  Sect.  XIV.  8.  The 
proximate  causes  of  both  of  them  therefore  consist  in  deficient 
irritation,  when  they  are  considered  as  pains;  because  these  pains 
are  in  consequence  of  the  inactivity  of  the  organ,  according  to 
the  fifth  law  of  animal  causation.  Sect.  IV.  5.  But  when  they 
are  considered  as  desires,  namely,  of  liquid  or  solid  aliment, 
their  proximate  cause  consists  in  the  pain  of  them,  according  to 
the  sixth  law  of  animal  causation.  So  the  proximate  cause  of 
the  pain  of  coldness  is  the  inactivity  of  the  organ,  and  perhaps 
the  consequent  accumulation  of  sensorial  power  in  it;  but  the 
pain  itself  or  the  consequent  volition,  is  the  proximate  cause  of 

VOL.  it.  p 


10G 


DISEASES 


Class  I.  2.  4.  2. 


the  shuddering  and  gnashing  the  teeth  in  cold  fits  of  intermittent 
fevers.  See  Class  t.  2.  2.  1. 

Thirst  may  be  divided  into  two  varieties,  alluding  to  the  re- 
mote cause  of  each,  and  may  be  termed  sitis  calida,  or  warm 
thirst,  and  sitis  frigida,  or  cold  thirst.  The  remote  cause  of  the 
former  arises  from  the  dissipation  of  the  aqueous  parts  of  our 
fluids  by  the  increased  secretion  of  perspirable  matter,  or  other 
evacuations.  And  hence  it  occurs  in  hot  fits  of  fever,  and  after 
taking  much  wine,  opium,  spice,  salt,  or  other  drugs  of  the  Art. 
incitantia  or  secernentia.  The  thirst,  which  occurs  about  three 
hours  after  eating  a couple  of  red  herrings,  to  a person  unaccus- 
tomed to  salted  meat,  is  of  this  kind;  the  increased  action  of  the 
cutaneous  vessels  dissipates  so  much  of  our  fluids  by  insensible 
perspiration,  as  to  require  above  two  quarts  of  water  to  restore 
the  fluidity  of  the  blood,  and  to  wash  the  salt  out  of  the  system. 
See  Art.  III.  2.  1. 

M.  M.  Cold  w'ater.  Vegetable  acids.  Warm  bath. 

The  remote  cause  of  sitis  frigida,  or  cold  thirst,  is  owing  to  the 
inaction  of  the  cutaneous,  pulmonary,  urinary,  and  cellular  ab- 
sorbents; whence  the  blood  is  deprived  of  the  great  supply  of 
moisture  which  it  ought  to  receive  from  the  atmosphere,  and  from 
the  cells  of  the  cellular  membrane,  and  from  other  cysts;  this 
cause  of  thirst  exists  in  dropsies,  and  in  the  eold  fits  of  intermit- 
tents.  The  desire  of  fluids,  like  that  of  solids,  is  liable  to  acquire 
periods,  and  may  therefore  readily  become  diseased  by  indulgence 
in  liquids  grateful  to  the  palate. 

Of  diseased  thirst,  the  most  common  is  either  owing  to  defect 
of  the  action  of  the  numerous  absorbent  vessels  on  the  neck  of 
the  bladder,  in  which  the  patient  makes  much  palish  water,  or 
to  the  defective  absorption  of  the  skin  and  lungs,  in  which  the 
patient  makes  but  little  water,  and  that  high-coloured,  and  with 
sediment.  In  both  the  tongue  and  lips  are  liable  to  become  very 
dry.  The  former  in  its  greatest  degree  attends  diabetes,  and  the 
latter  anasarca. 

M.  M.  Warm  water,  warm  wine,  warm  bath.  Opium.  Cold 
bath.  Iced  water.  Lemonade.  Cider. 

2.  Esuries.  Hunger  has  been  fancifully  ascribed  to  the  sides 
of  the  stomach  rubbing  against  each  other,  and  to  the  increased 
acidity  of  the  gastric  juice  corroding  the  coats  of  it.  If  either 
of  these  were  the  cause  of  hunger,  inflammation  must  occur,  when 
they  had  continued  some  time;  but,  on  the  contrary,  coldness 
not  heat  is  attendant  on  hunger;  which  evinces,  that,  like  thirst, 
it  is  owing  to  the  inactivity  of  the  membrane,  which  is  the  seat 
of  it;  while  the  abundant  nerves  about  the  cardia  ventriculi. 


OP  IRRITATION. 


Class  I.  2.  4.  3. 


107 


and  the  pain  of  hunger  being  felt  in  that  part,  gives  great  reason 
to  conclude,  that  it  is  there  situated. 

The  sense  of  hunger  as  well  as  of  thirst,  is  liable  to  acquire 
habits  in  respect  to  the  times  of  its  returning  painfulness,  as  well 
as  in  respect  to  the  quantity  required  to  satiate  its  appetency, 
and  hence  may  become  diseased  by  indulgence,  as  well  as  by 
want  of  its  appropriate  stimulus.  Those  who  have  been  accus- 
tomed to  distend  their  stomach  by  large  quantities  of  animal  and 
vegetable  food,  and  much  potation,  find  a'  want  of  distention, 
when  the  stomach  is  empty,  which  occasions  faintness,  and  is 
mistaken  for  hunger,  but  which  does  not  appear  to  be  the  same 
sensation.  1 was  well  informed,  that  a woman  near  Litchfield, 
who  eat  much  animal  and  vegetable  food  for  a wager,  affirmed, 
that  since  distending  her  stomach  so  much,  she  had  never  felt 
herself  satisfied  with  food;  and  had  in  general  taken  twice  as 
much  at  a meal,  as  she  had  been  accustomed  to,  before  she  eat  so 
much  for  a wager. 

3.  Nausea  sicca.  Dry  nausea.  Consists  in  a quiescence  or 
torpor  of  the  mucous  or  salivary  glands,  and  precedes  their  in- 
verted motions,  described  in  nausea  humida,  Class  I.  3.  2.  3. 
In  the  same  manner  as  sickness  of  the  stomach  is  a quiescence 
of  that  organ  preceding  the  action  of  vomiting,  as  explained  in 
Sect.  XXXV.  1.  3.  This  is  sometimes  induced  by  disagreeable 
drugs  held  in  the  mouth,  at  other  times  by  disgustful  ideas,  and 
at  other  times  by  the  association  of  these  actions  with  those  of 
the  stomach;  and  thus  according  to  its  different  proximate 
causes  may  belong  to  this,  or  to  the  second,  or  to  the  fourth  class 
of  diseases. 

M.  M.  Lemonade.  Tasteful  food.  A blister.  Warm  bath. 

4.  JEgritudo  ventriculi.  Sickness  of  stomach  is  produced  by 
the  quiescence  or  inactivity  of  that  organ,  as  is  explained  in 
Sect.  XXXV.  1.3.  It  consists  in  the  state  between  the  usual 
peristaltic  motions  of  that  organ,  in  the  digestion  of  our  aliment 
and  the  retrograde  motions  of  it  in  vomiting;  for  it  is  evident, 
that  the  direct  motions  of  it  from  the  cardia  to  the  pylorus  must 
stop,  before  those  in  a contrary  direction  can  commence.  This 
sickness,  like  the  nausea  above  described,  is  sometimes  produced 
by  disgustful  ideas,  as  when  nasty  objects  are  seen,  and  nasty 
stories  related,  as  well  as  by  the  exhaustion  of  the  sensorial 
power  by  the  stimulus  of  some  emetic  drugs,  and  by  the  defect  of 
the  production  of  it,  as  in  enfeebled  drunkards. 

Sickness  may  likewise  consist  in  the  retrograde  motions  of  the 
lymphatics  of  the  stomach,  which  regurgitate  into  it  the  chyle  or 
lymph,  which  they  have  lately  absorbed,  as  in  Class  I.  3.  2. 3.  It 
is  probable,  that  these  two  kinds  of  sickness  may  be  different  sen- 


108 


DISEASES 


Class  I.  2.  4.  o'- 


sations,  though  they  have  acquired  but  one  name;  as  one  of  them 
attends  hunger,  and  the  other  repletion;  though  either  of  them 
may  possibly  be  induced  by  association  with  nauseous  ideas. 

M.  M.  A blister  on  the  back.  An  emetic.  Opium.  Crude 
mercury.  Covering  the  head  in  bed.  See  Sect.  XXV.  16.  Class 
IV.  1.  1.  2.  and  3. 

5.  Cardialgia.  Ilartburn  originates  from  the  inactivity  of 
the  stomach,  whence  the  aliment,  instead  of  being  subdued  by 
digestion,  and  converted  into  chyle,  runs  into  fermentation,  pro- 
ducing acetous  acid.  Sometimes  the  gastric  juice  itself  becomes 
so  acid  as  to  give  pain  to  the  upper  orifice  of  the  stomach;  these 
acid  contents  of  the  stomach,  on  falling  on  a marble  hearth, 
have  been  seen  to  produce  an  effervescence  on  it.  The  pain  of 
heat  at  the  upper  end  of  the  gullet,  when  any  air  is  brought  up 
from  the  fermenting  contents  of  the  stomach,  is  to  be  ascribed 
to  the  sympathy  between  these  two  extremities  of  the  oesophagus, 
rather  than  to  the  pungency  of  the  carbonic  gas,  or  fixed  air; 
as  the  sensation  of  swallowing  that  kind  of  air  in  wyater  is  of  a 
different  kind.  See  Class  I.  3.  1.  3.  and  IV.  2.  2.  5. 

M.  M.  This  disease  arising  from  indigestion  is  often  very  per- 
tinacious, and  afflicting;  and  attended  with  emaciation  of  the 
body  from  want  of  sufficient  chyle.  As  the  saliva  swallowed 
along  with  our  food  prevents  its  fermentation,  as  appears  by  the 
experiments  of  Pringle  and  Macbride,  some  find  considerable  re- 
lief by  chewing  parched  wheat,  or  mastic,  or  a lock  of  wool,  fre- 
quently in  a day,  when  the  pain  occurs,  and  by  swallowing  the 
saliva  thus  effused;  a temporary  relief  is  often  obtained  from  an- 
tiacids, or  aerated  alkaline  water,  Seltzer  water,  calcareous  earths, 
alkaline  salts  made  into  pills  with  soap,  soap  alone,  tin,  milk, 
bitters.  More  permanent  use  may  be  had  from  such  drugs  as 
check  fermentation,  as  acid  of  vitriol;  but  still  more  permanent 
relief  from  such  things  as  invigorate  the  digestion,  as  a blister  on 
the  back;  a due  quantity  of  vinous  spirit  and  water  taken 
regularly.  Steel.  Temperance.  A sleep  after  dinner.  A waist- 
coat made  so  tight  as  slightly  to  compress  the  bowels  and  sto- 
mach. A flannel  shirt  in  winter,  not  in  summer.  A less  quan- 
tity of  potation  of  all  kinds.  Ten  black  pepper-corns  swallowed 
after  dinner.  Half  a grain  of  opium  twice  a day,  or  a grain. 
The  food  should  consist  of  such  things  as  do  not  easily  ferment, 
as  flesh,  shell-fish,  sea-bisenit,  toasted  cheese.  I have  seen  toasted 
cheese  brought  up  from  the  stomach  24  hours  after  it  bad  been 
swallowed,  without  apparently  having  undergone  any  chemical 
change.  See  Class  II.  1.  3.  i7.  and  IV.  1.  2.  13. 

It  is  probable  that  violent  cardialgia  is  most  frequently  owing 
to  increase  of  the  quantity  or  acidity  of  the  gastric  juice,  rather 


Cixss  J.  2.  4.  6. 


OF  IRRITATION. 


109 


than  to  the  acetous  acid  produced  by  fermenting  aliment;  be- 
cause in  violent  apepsy,  as  in  low  fevers,  and  total  want  of  di- 
gestion, no  such  violently  strong  or  painful  acidity  occurs.  See 
I.  3.  1.  3.  See  Anorexia  II.  2.2.  1.  And  secondly,  because 
in  all  these  cases,  which  have  come  under  my  eye,  the  disease 
was  not  increased  by  vegetable  food,  or  even  by  acid  fruits,  when 
taken  in  their  usual  quantity;  and  I have  uniformly  observed, 
that  the  food  which  suited  the  palate,  and  that  water  alone,  or 
small  wine  and  water,  agreed  with  these  patients  better  than 
stronger  mixtures  of  spirit  and  water,  especially  when  they  were 
more  agreeable  to  the  palate. 

6.  Arthritis  Ventriculi.  Sickness  of  the  stomach  in  gouty 
cases  is  frequently  a consequence  of  the  torpor  or  inflammation 
of  the  liver,  and  then  it  continues  many  days  or  weeks.  But 
when  the  patient  is  seized  with  great  pain  at  the  stomach  with 
the  sensation  of  coldness,  which  they  have  called  an  ice-bolt, 
this  is  a primary  affection  of  the  stomach,  and  destroys  the  pa- 
tient in  a few  hours,  owing  to  the  torpor  or  inaction  of  that  viscus 
so. important  to  life. 

This  primary  gout  of  the  stomach,  as  it  is  a torpor  of  that  vis- 
cus, is  attended  with  sensation  of  coldness,  and  with  real  defect 
of  heat  in  that  part,  and  may  thence  be  distinguished  from  the 
pain  occasioned  by  the  passage  of  a gall-stone  into  the  duode- 
num, as  well  as  by  the  weak  pulse,  and  cold  extremities;  to 
which  must  be  added,  that  it  affects  those  only,  who  have  been 
long  afflicted  with  the  gout,  and  much  debilitated  by  its  nume- 
rous attacks. 

M.  M.  Opium.  Vinous  spirit.  Volatile  alkali.  Spice, 
Warmth  applied  externally  to  the  stomach  by  hot  cloths  or 
fomentation. 

7.  Colica  flatulenta.  The  flatulent  cholic  arises  from  the  too 
great  distention  of  the  bowels  by  air,  and  consequent  pain.  The 
cause  of  this  disease  is  the  inactivity  or  want  of  sufficiently  pow- 
erful contraction  of  the  coats  of  the  bowel,  to  carry  forwards  the 
gas  given  up  by  the  fermenting  aliment.  It  is  without  fever,  and 
generally  attended  with  cold  extremities. 

It  is  distinguished,  first,  from  the  pain  occasioned  by  the  pas- 
sage of  a gall-stone,  as  that  is  felt  at  the  pit  of  the  stomach,  and 
this  nearer  the  navel.  Secondly,  it  is  distinguished  from  the  co- 
lica saturnina,  or  colic  from  lead,  as  that  arising  from  the  torpor 
of  the  liver,  or  of  some  other  viscus,  is  attended  with  greater 
coldness,  and  with  an  aching  pain;  whereas  the  flatulent  colic 
being  owing  to  distention  of  the  muscles  of  the  bowel,  the  pain 
is  more  acute,  and  the  coldness  less.  Thirdly,  it  is  distinguish- 
ed from  inflammation  of  the  bowels,  or  ileus,  as  perpetual  vomit- 


110 


DISEASES 


Class  I.  2.  4.  8. 


ing  and  fever  attend  this.  Fourthly,  it  is  distinguished  from 
cholera,  because  that  is  accompanied  with  both  vomiting  and 
diarrhoea.  And  lastly,  from  the  colica  epileptica,  or  hysteric 
colic,  as  that  is  liable  to  alternate  with  convulsion,  and  sometimes 
with  insanity;  and  returns  by  periods. 

M.  M.  Spirit  of  wine  and  warm  water,  one  spoonful  of  each. 
Opium  one  grhin.  Spice.  Volatile  alkali.  Warm  fomentation 
externally.  Rhubarb. 

8.  Colica  saturnina.  Colic  from  lead.  The  pain  is  felt  about 
the  navel,  is  rather  of  an  aching  than  acute  kind  at  first,  which 
increases  after  meals,  and  gradually  becomes  more  permanent 
and  more  acute.  It  terminates  in  paralysis,  frequently  of  the 
muscles  of  the  arm,  so  that  the  hand  hangs  down,  when  the 
arm  is  extended  horizontally.  It  is  not  attended  with  fever,  or 
increase  of  heat.  The  seat  of  the  disease  is  not  well  ascertained; 
it  probably  affects  some  part  of  the  liver,  as  a pale  bluish  coun- 
tenance and  deficiency  of  bile  sometimes  attend  or  succeed  it, 
with  consequent  anasarca;  but  it  seems  to  be  caused  immedi- 
ately by  a torpor  of  the  intestine,  whether  this  be  a primary  or 
secondary  affection,  as  appears  from  the  constipation  of  the 
bowels,  which  attends  it;  and  is  always  produced  in  conse- 
quence of  the  great  stimulus  of  lead  previously  used  either  inter- 
nally fora  length  of  time,  or  externally  on  a large  surface. 

A delicate  young  girl,  daughter  of  a dairy  farmer,  wrho  kept 
his  milk  in  leaden  cisterns  used  to  wipe  off  the  cream  from  the 
edges  of  the  lead  with  her  finger;  and  frequently,  as  she  was  fond 
of  cream,  licked  it  from  her  finger.  She  uras  seized  with  the 
saturnine  colic,  and  semi-paralytic  wrists,  and  sunk  from  gene- 
ral debility. 

A feeble  woman  about  forty  years  of  age,  sprained  her  ancle, 
and  bruised  her  leg  and  thigh;  and  applied,  by  ill  advice,  a solu- 
tion of  lead  over  the  whole  limb,  as  a fomentation  and  poultice 
for  about  a fortnight.  She  was  then  seized  with  the  colica  sa- 
turnina, lost  the  use  of  her  wrists,  and  gradually  sunk  under  a 
general  debility. 

There  are  various  means  by  which  lead  finds  its  way  into  the 
system;  in  the  cider  counties  of  this  country  this  disease  has 
been  frequently  almost  epidemic,  from  the  use  of  some  lead  about 
their  mills,  or  by  the  pernicious  use  of  it  to  correct  the  acidity  of 
weak  cider.  This  disease  has  been  so  frequent  in  some  ot  the 
W'ine  countries,  that  in  France  the  punishment  of  death  is  di- 
rected for  those  who  use  lead  to  destroy  the  acidity  of  wine. 

There  is  a bad  custom  in  almost  all  families  and  public  houses, 
of  washing  out  their  bottles  by  putting  a handful  of  shot  corns 
into  them,  and  by  shaking  them  about  forcibly,  by  which  the 


Class.  I.  2.  4.  8. 


OF  IRRITATION'. 


Ill 


lead  may  in  part  adhere  to  the  sides  of  the  bottle,  and  become 
dissolved  in  the  acid  of  the  wine  or  cider.  Milk  kept  in  lead  is 
highly  pernicious,  as  in  the  instance  above  related.  Nor  should 
coppers  for  brewing  be  edged  at  the  top  of  them  with  lead,  which 
is  frequently  done;  nor  should  flesh-meat  be  salted  in  leaden 
cisterns.  Another  way  by  which  lead  is  liable  to  be  taken  into 
the  stomach  is  by  broth,  which  is  boiled  in  copper  vessels 
tinned  within.  Now  the  lining  of  these  vessels  consists,  I am 
well  informed,  of  nearly  half  lead  mixed  with  the  tin;  which  is 
very  soluble  in  hot  grease.  From  this  cause  those  who  live 
much  on  soups  long  boiled,  as  the  French,  are  perpetually  sub- 
ject to  complaints  of  the  stomach  and  intestines.  When  a 
sauce-pan  has  been  new  tinned,  if  the  finger  be  rubbed  hard  on 
it,  it  becomes  black;  which  is  owing  to  the  lead,  which  is  mixed 
with  the  tin.  Hence  the  broth  for  all  sick  people  should  be 
boiled  but  a short  time,  and  be  immediately  put  into  a china- 
bason. 

In  an  ingenious  pamphlet  lately  published  by  Mr.  Clutterbuck, 
several  cases  are  given  of  the  successful  use  cf  mercury  in  the 
constipation,  colic,  and  paralysis  of  the  wrists,  produced  by  lead. 
In  some  of  these  patients  a drachm  of  strong  mercurial  ointment 
was  rubbed  morning  and  night  on  the  wrists,  till  the  mouth  be- 
came sore.  In  others  calomel  one  grain  was  given  daily  with  ol. 
ricini;  and  in  others  a quarter  of  a grain  of  hydragyrum  muria- 
tum,  sublimate  of  mercury,  was  given  three  times  a day  with 
great  apparent  advantage.  The  author  ingeniously  asks,  if 
small  doses  of  some  preparation  of  lead  might  not  be  given  inter- 
nally to  counteract  the  ill  effects  sometimes  believed  to  result  from 
the  too  long  use  of  mercury.  On  the  Poison  of  Lead,  Boosey, 
Lond.  See  Class  III.  2.  1.  4. 

The  effect  of  metals  in  destroying  or  preventing  the  acidity 
of  wine  or  cider,  may  be  nicely  observed  in  attending  to  the 
colour  of  syrup  of  violets;  which,  if  it  ferments,  is  changed  by 
the  acid  thus  produced  from  blue  to  red:  but  if  it  be  kept  in  a 
tin  vessel,  this  does  not  occur;  as  the  acid  is  attracted  by  the 
metal  producing  an  oxyde.  Other  metals  are  said  by  M.  Guy- 
ton, to  have  the  same  effect  in  preserving  the  colour  of  syrup  of 
violets. 

M.  M.  First  opium  one  or  two  grains,  then  a cathartic  of 
senna,  jalap,  and  .oil,  as  soon  as  the  pain  is  relieved.  Oleum 
ricini.  Alum.  Oil  of  almonds.  A blister  on  the  navel.  Warm 
bath.  The  stimulus  of  the  opium,  by  restoring  to  the  bowels  its 
natural  irritability  in  this  case  of  painful  torpor,  assists  the  action 
of  the  cathartic.  A clyster  of  the  smoke  of  tobacco  pushed  high 


112 


DISEASES 


Class  T.  2.  4.  9. 


up  and  continued,  or  repeated  frequently  for  an  hour  or  two,  or 
longer,  is  said  to  remove  the  pain,  and  totally  to  cure  the  disease. 

9.  Tympanitis.  Tympany  consists  in  an  elastic  tumour  of  the 
abdomen,  which  sounds  on  being  struck.  It  is  generally  attend- 
ed with  costiveness  and  emaciation.  In  one  kind  the  air  is  said 
to  exist  in  the  bowels,  in  which  case  the  tumour  is  less  equal, 
and  becomes  less  tense  and  painful  on  the  evacuation  of  air.  In 
the  other  kind  the  air  exists  in  the  cavity  of  the  abdomen,  and 
sometimes  is  in  a few  days  exchanged  for  water,  and  the  tym- 
pany becomes  an  ascites. 

Air  may  be  distinguished  in  the  stomachs  of  many  people  by 
the  sound  on  striking  it  with  the  fingers,  and  comparing  the 
sound  with  that  of  a similar  percussion  on  other  parts  of  the 
bowels:  but  towards  the  end  of  fevers  and  especially  in  the 
puerperal  fever,  a distention  of  the  abdomen  by  air  is  generally 
a fatal  symptom,  though  the  ease,  and  often  cheerfulness  of  the 
patient,  vainly  flatters  the  attendants. 

M.  M.  In  the  former  case  a clyster-pipe  unarmed  may  be  in- 
troduced, and  left  some  time  in  the  rectum,  to  lake  off  the  re- 
sistance of  the  sphincter,  and  thus  discharge  the  air,  as  it  is  pro- 
duced from  the  fermenting  or  putrefying  aliment.  For  this 
purpose,  in  a disease  somewhat  similar  in  horses,  a perforation  is 
made  into  the  rectum  on  one  side  of  the  sphincter;  through 
which  fistula  the  air,  which  is  produced  in  such  great  excess 
from  the  quantity  of  vegetable  food  which  they  take,  when  their 
digestions  are  impaired,  is  perpetually  evacuated.  In  both  cases 
also,  balsams,  essential  oil,  spice,  bandage  on  the  abdomen,  and, 
to  prevent  the  fermentation  of  the  aliment,  acid  of  vitriol,  saliva. 
See  Class  I.  2.  4.  5. 

10.  Hypochondriasis.  The  hypochondriac  disease  consists  in 
indigestion  and  consequent  flatulency,  with  anxiety  or  want  of 
pleasurable  sensation.  When  the  action  of  the  stomach  and 
bowels  is  impaired,  much  gas  becomes  generated  by  the  ferment- 
ing or  putrescent  aliment,  and  to  this  indigestion  is  catenated 
languor,  coldness  of  the  skin,  and  fear.  For  when  the  extremi- 
ties are  cold  for  too  long  a time  in  some  weak  constitutions,  indi- 
gestion is  produced  by  direct  sympathy  of  the  skin  and  ihe  sto- 
mach, with  consequent  heartburn,  and  flatulency.  The  same 
occurs,  if  the  skin  be  made  cold  by  fear,  as  in  riding  over  dan- 
gerous roads  in  wdnter,  and  hence  conversely.fear  is  produced 
by  indigestion  or  torpor  of  the  stomach  by  association. 

This  disease  is  confounded  with  the  fear  of  death,  which  is 
an  insanity,  and  therefore  of  a totally  different  nature.  It  is 
also  confounded  with  the  hysteric  disease,  which  consists  in  the 


Class  1. 2. 4 11.  OF  IRRITATION.  113 

retrograde  motions  of  the  alimentary  canal,  and  of  some  parts  of 
the  absorbent  system. 

The  hypochondriasis,  like  chlorosis,  is  sometimes  attended  with 
very  quick  pulse;  which  the  patient  seems  to  bear  so  easily  in 
these  two  maladies,  that  if  an  accidental  cough  attends  them, 
they  may  be  mistaken  for  pulmonary  consumption;  which  is 
not  owing  primarily  to  the  debility  of  the  heart,  but  to  its  direct 
sympathy  with  the  actions  of  the  stomach. 

M.  M.  Blister.  A plaster  of  Burgundy  pitch  on  the  abdo- 
men. Opium  a grain  twice  a day.  Rhubarb  six  grains  every 
night.  Bark.  Steel.  Spice.  Bath-water.  Siesta,  or  sleep 
after  dinner.  Uniform  hours  of  meals.  No  liquor  stronger 
than  small  beer,  or  wine  and  water.  Gentle  exercise  on  horse- 
back in  the  open  air  uniformly  persisted  in.  See  Cardialgia,  I, 
2.  4.  5. 

1 1 . Cephalcca  idiopathica.  Head-achs  which  are  attended  with 
inflammation,  are  termed  phrenitis,  described  in  Class  II.  1. 
2.  3.  Those  which  are  not  attended  with  inflammation,  may 
be  divided  into  such  as  affect  the  whole  head,  to  which  the 
word  cephalaea  is  applied,  and  into  such  as  affect  one  side  of  the 
head  only  at  a time,  which  is  termed  hemicrania.  The  former 
of  these  may  be  divided  into  cephalaea  idiopathica,  and  cephalaea 
sympathetica;  and  the  latter  into  hemicrania  idiopathica,  and 
hemicrania  sympathetica.  Besides  these  there  exists  a cephalaea 
somniosa,  a cephalaea  syphilitica,  and  a cephalaea  hydropica. 

The  idiopathic  head-ach  frequently  attends  the  cold  paroxysm 
of  intermittents;  afflicts  inebriates  the  day  after  intoxication; 
and  many  people  who  remain  too  long  in  the  cold  bath.  In  all 
which  cases  there  is  a general  inaction  of  the  whole  system,  and 
as  these  membranes  about  the  head  have  been  more  exposed  to 
the  variations  of  heat  and  cold  of  the  atmosphere,  they  are  more 
liable  to  become  affected  so  far  as  to  produce  sensation,  than  other 
membranes;  which  are  usually  covered  either  with  clothes,  or 
with  muscles,  as  mentioned  in  Sect.  XXXIII.  2.  10. 

The  promptitude  of  the  membranes  about  the  scalp  to  sym- 
pathize with  those  of  other  parts  of  the  system  is  so  great,  that 
this  cephalasa  without  fever,  or  quickness  of  pulse,  is  more  fre- 
quently a secondary  than  a primary  disease,  and  then  belongs  to 
Class  IV.  2.  2.  7.  The  hemicrania,  or  partial  head-ach,  I be- 
lieve to  be  almost  always  a disease  from  association;  though  it 
is  not  impossible,  but  a person  may  take  cold  on  one  side  of  the 
head  only.  As  some  people  by  sitting  always  on  the  same  side 
of  the  fire  in  winter  are  liable  to  render  one  side  more  tender 
than  the  other,  apd  in  consequence  more  subject  to  pains,  which 
have  been  erroneously  termed  rheumatic. 

VOL.  II.  ' q 


114 


DISEASES 


Class  I.  2.  4.  11. 


M.  M.  The  method  of  cure  consists  in  rendering  the  habit 
more  robust,  by  gentle  constant  exercise  in  the  open  air,  flesh 
diet,  small  bear  at  meals  with  one  glass  of  wine,  regular  hours 
of  rest  and  rising,  and  of  meals.  The  clothing  about  the  head 
should  be  warmer  during  sleep  than  in  the  day;  because  at  that 
time  people  are  more  liable  to  take  cold;  that  is  the  membranous 
parts  of  it  are  more  liable  to  become  torpid;  as  explained  in  Sect. 
XVIII.  15.  In  respect  to  medicine,  two  drams  of  valerian 
root  in  powder  three  or  tour  times  a day  are  recommended  by 
Fordyce.  The  bark.  Steel  in  moderate  quantities.  An  eme- 
tic. A blister.  Opium,  half  a grain  twice  a day.  Decayed 
teeth  should  be  extracted,  particularly  such  as  either  ache  or  are 
useless.  Cold  bath  between  60  and  70  degrees  of  heat.  Warm 
bath  of  94  or  98  degrees  every  day  for  half  an  hour  during  a 
month.  See  Class  IV.  2.  2.  7.  and  8.  and  IV.  2.  4.  3. 

A solution  of  arsenic,  about  the  sixteenth  part  of  a grain,  is  re- 
ported to  have  great  effect  in  this  disease.  It  should  be  taken 
thrice  a day,  if  it  produces  no  griping  or  sickness,  for  two  or 
three  weeks.  A medicine  of  this  kind  is  sold  under  the  name 
of  tasteless  ague-drops:  but  a more  certain  method  of  ascer- 
taining the  quantity  is  delivered  in  the  preceding  Materia  Medi- 
ca,  Art.  IV.  2.  6.  8.  Five  grains  of  the  powdered  leaves  of 
Atropa  Belladonna  are  recommended  in  some  foreign  publication 
to  be  repeated  once  in  two  days,  and  are  said  to  be  successful  in 
the  dolor  faciei,  or  hemicrania  idiopathica. 

Cephaloia  Somniosa.  Head-ache  from  sleep.  This  disease 
has  not  been  described,  I believe,  by  any  writer,  though  it  affects 
some  invalids  for  years.  After  some  hours  of  sleep  the  patients 
are  afflicted  with  distressing  dreams,  and  awake  with  pain  of  the 
head,  which  continues  for  some  time  after  they  awake;  and  so 
circumstanced  furnishes  the  diagnostic  symptom  of  this  species 
of  cephalaea. 

The  paroxysms  or  repetitions  of  many  diseases  are  liable  to 
commence  in  sleep,  some  from  the  increase  of  sensibility  during 
sleep,  as  explained  in  Sect.  XVIII.  5.  and  15.  of  the  first  part  of 
this  work,  as  those  of  some  epilepsies,  of  some  asthmas,  and  of 
the  gout.  Other  diseases  are  liable  to  return  during  sleep  from 
the  debility  of  the  pulmonary  circulation,  or  of  pulmonary  ab- 
sorption, as  in  somnus  interrupts,  Class  I.  2.  1.  3.  and  in  in- 
cubus, or  night-mare,  Class  III.  2.  1.  13.  and  in  hsemoptoe 
venosa,  Class  I.  2.  1.  9.  and  probably  in  the  humoral  asthma, 
Class  II.  1.  1.  8. 

The  cephalaea  somniosa  I suspect  to  bear  the  same  analogy  to 
the  hydrocephalus  internus,  as  I believe  the  asthma  humorale  to 
bear  to  the  anasarca  pulmonum;  and  to  consist  in  this  circura- 


CtAss  I.  2.  4. 12. 


OP  IRRITATION. 


115 


stance,  that  during  sleep  in  the  cephalaea  somniosa  a temporary- 
congestion  of  fluid  may  occur  in  some  part  of  the  brain,  as  a 
permanent  one  occurs  in  the  hydrocephalus  internus;  in  the 
same  manner  as  I believe  in  the  asthma  humorale,  a temporary 
congestion  of  fluid  occurs  in  some  part  within  the  chest,  and  a 
permanent  one  in  the  anasarca  of  the  lungs. 

M.  M.  The  patient  should  sleep  with  his  head  raised  high 
on  many  pillows,  and  wear  drawers  to  prevent  his  slipping  down 
in  the  bed.  2.  He  should  sleep  on  a hardish  bed,  or  mattress,  to 
prevent  his  sleeping  too  profoundly,  or  too  long  together.  8. 
Or  he  may  be  wakened,  after  having  slept  a certain  number  of 
hours  by  an  alarm  clock..  4.  Any  carious  teeth  should  be  ex- 
tracted, as  the  matter  from  putrid  bones,  swallowed  with  the 
saliva,  weakens  the  system  by  its  effect  on  the  stomach.  5. 
Twenty  drops  of  saturated  tincture  of  digitalis  may  be  taken 
twice  or  thrice  a day  for  three  or  four  weeks.  6.  Half  a grain 
of  opium  and  six  grains  of  rhubarb  should  be  taken  every  night 
for  many  weeks  or  months.  7.  Oxygen  gas  may  be  respired 
daily  for  a time,  till  its  effect  can  be  known. 

12.  Hemicrania  idiopathica.  This  disease  is  described  by  Sau- 
vages,  under  the  name  of  trismus  dolorificus,  or  tic  douloureux, 
in  Class  IV.  ord,  1.  gen.  2.  spec.  14.  of  his  elaborate  work.  Bui 
the  word  trismus  is  an  improper  name,  as  no  fixed  spasm  like  the 
locked  jaw  exists  in  this  malady,  nor  any  stridor  dentium,  or  con- 
vulsion of  the  muscles  of  the  face,  or  trick,  attends  these  patients 
in  the  few  cases  which  I have  witnessed,  though  this  may  possi- 
bly occur  occasionally  as  the  consequence  of  disagreeable  sensa- 
tion, or  to  relieve  it.  I suppose  the  word  tic  douloureux  is  a 
vulgar  French  expression,  like  megrim  in  English. 

The  cause  of  this  afflicting  disease  is  yet  unknown.  As  it 
does  not  appear  to  sympathize  with  a diseased  tooth,  like  the  he- 
micrania sympathetica,  described  in  Class  IV.  2.  2.  8.  I sus- 
pect the  cause  to  consist  in  a diseased  state  of  the  nerve  itself,  or 
of  its  covering  or  theca,  and  to  resemble  the  sciatica  frigida, 
mentioned  below;  or  to  resemble  some  of  those  pains,  which  are 
succeeded  or  relieved  by  epileptic  convulsions,  described  in  Class 
III.  1.  1.  8.  and  that  it  thus  differs  from  the  hemicrania  sym- 
pathetica; as  in  this  the  cause  of  the  disease,  and  the  seat  of  the 
pain,  exist  in  the  same  place. 

One  case,  which  occurred  to  me  long  ago,  of  this  disease,  was 
of  an  elderly  gentleman,  Mr.  W.  of  Litchfield,  who  had  long 
lost  all  his  teeth;  the  pain  began  chiefly  about  the  cheek-bone, 
and  extended  sometimes  to  the  ala  of  the  nose,  and  to  other  parts 
of  the  face  on  the  same  side;  on  examining  the  gums  of  the  up- 
per jaw,  there  was  no  suspicion  of  any  stump  of  a decayed  tooth 


116 


DISEASES 


Class  I.  2.  4.  12. 


remaining  in  the  alveolar  processes;  nor  was  there  any  reason  to 
suspect  any  disease  of  the  maxillary  sinus.  Whence  this  did  not 
appear  to  be  any  kind  of  sympathetic  hemicrania.  He  was  af- 
flicted with  it  for  many  years  till  his  death. 

The  case  of  Mr.  B.  a gentleman  between  20  and  30  years  of 
age,  whom  I was  lately  concerned  for,  in  this  disease,  is  well 
worthy  a minute  description;  I shall  therefore  copy  aletter,  which 
I wrote  on  his  case  to  Mr.  Cruikshank,  and  an  answer  I receiv- 
ed some  time  after  from  his  partner,  Mr.  Leigh  Thomas,  who  I 
hope  will  publish  the  successful  method  of  cure,  with  adapted 
prints. 

To  Mr.  Cruikshank. 

Sir,  Derby , Dec.  1789. 

Mr.  Bosworth,  whose  case  I wish  to  remind  you  of,  consulted 
you  some  time  ago  in  London,  and  I believe  that  you  then  told 
him,  that  his  head-ach  was  owing  to  a disease  of  the  third  branch 
of  the  fifth  pair  of  nerves.  He  came  under  my  care  at  Derby,  a 
lew  weeks  ago,  and  complained  of  much  pain  about  the  left 
cheek-bone;  I suspected  the  antrum  maxillare  might  be  diseased, 
and  as  the  second  of  the  dentes  molares  had  then  been  lately  ex- 
tracted, I desired  a perforation  might  be  made  into  the  antrum, 
which  was  done  by  Mr.  Hadley,  of  this  town,  and  kept  open 
for  two  or  three  days  without  advantage.  Afterwards,  by  fric- 
tion about  the  head  and  neck  with  mercurial  unguent,  he  was 
copiously  salivated  for  a few  days,  and  had  another  tooth  extract- 
ed by  his  own  desire,  and  had  lastly  an  incision  made  by  Mr. 
Hadley,  so  as  to  divide  the  artery  near  the  centre  of  the  ear  next 
the  cheek,  hoping  to  divide  a branch  of  the  affected  nerve,  but 
without  success;  and  internally,  opiates  in  large  quantity  were 
given,  when  the  pain  was  exceedingly  violent,  the  bark  also  was 
used  for  a time  in  large  quantity  without  effect. 

On  attending,  as  much  as  I could,  to  his  sensations  when  in 
pain,  he  seems  to  express  the  commencement  of  the  periods  of 
pain  to  exist  about  the  part  of  the  left  cheek  before  the  middle 
of  the  ear;  and  then  draws  his  finger  from  thence  to  the  fore 
part  of  the  lower  jaw  sometimes,  and  to  the  ala  of  the  nose  on 
that  side;  and  at  other  times  he  draws  his  finger  from  the  same 
part  of  the  cheek  before  the  ear  upwards  to  the  orbit  of  the  eye, 
and  from  thence  downwards,  a little  way  on  the  nose;  and  also 
he  complains  of  pain  under  his  tongue  on  the  same  side.  The 
pain  returns  many  times  in  an  hour  on  some  days,  and  continues 
many  minutes,  during  which  he  seems  to  stretch  and  exert  his 
arms,  and  appears  to  have  a tendency  to  epileptic  actions;  and 


Ciass  I.  2.  4.  12.  OF  IRRITATION.  1 17 

his  life  is  thus  miserable  to  himself,  and  uncomfortable  for  his 
friends  to  witness. 

I write  this  to  you  to  beg  that  you  will  acquaint  Mr.  Bos- 
worth,  wrhether  you  think  you  could  divide  by  incision  the  dis- 
eased nerve;  as  he  is  willing  to  undergo  such  an  operation,  if  you 
think  it  practicable,  as  I believe  it  to  be  the  only  means  which 
promises  to  cure  him;  and  have  therefore  advised  him  again  to 
apply  to  you;  and  if  you  think  this  can  be  done  with  effect,  he 
designs  to  wait  on  you  in  London. 

I am,  sir,  &c. 

E.  Darwin. 

The  following  answer  of  Mr.  Leigh  Thomas  shews  the  disease 
to  have  existed  in  every  branch  of  the  affected  nerve. 

Sir,  Leicester-square , J\'Iay,  1799. 

About  the  middle  of  December  last,  you  did  Mr.  Cruikshank 
the  favour  to  write  him  an  account  of  Mr.  Bosvvorth,  a young- 
gentleman,  some  time  under  your  care  at  Derby,  with  a painful 
affection  of  the  nerves  of  his  face.  The  patient  soon  after  came 
to  town  in  a much  worse  state,  than  you  described  him  to  be  at 
that  time;  as  the  pain  was  extremely  acute  and  almost  unremit- 
ting, opiates,  which  he  had  been  in  the  habit  of  taking  occasion- 
ally, afforded  him  now  little  or  no  relief,  though  taken  to  the 
quantity  of  six  tea-spoonfuls  of  laudanum  at  a time.  After  pay- 
ing every  attention  to  the  case,  your  suggestion  of  the  necessity 
of  dividing  the  diseased  nerve  appeared  obvious. 

As  the  pain  felt  was  more  acute  in  the  left  ala  of  the  nose,  and 
the  upper  lip  of  the  same  side,  we  were  induced  to  divide  the 
second  branch  of  the  fifth  pair  of  nerves,  as  it  passes  out  at  the  in- 
fraorbital foramen.  He  was  instantly  relieved  in  the  nose  and 
lip;  but  towards  plight  the  pain  from  the  eye  to  the  crown  of 
the  head  became  more  acute  than  ever.  Two  days  after,  we 
were  obliged  to  cut  through  the  first  branch  passing  out  at  the 
supra-orbital  foramen;  this  afforded  him  the  like  relief  with  the 
first.  On  the  same  day  the  pain  attacked,  with  great  violence, 
the  lower  lip  on  the  left  side,  and  the  chin;  this  circumstance 
induced  the  necessity  of  dividing  the  third  branch  passing  out  at 
the  foramen  mentale.  During  the  whole  period,  from  the  first 
division  of  the  nerves,  he  had  frequent  attacks  of  pain  on  the 
side  of  the  tongue;  these  however  disappeared  on  division  of  the 
last  nerve. 

Mr.  Cruikshank  performed  the  above  operations,  but  being 
particularly  engaged  at  this  time  with  lectures  and  other  busi- 
ness, he  now  gave  up  the  case  to  my  management.  The  patient 
was  evidently  bettered  by  each  operation;  still  the  pain  was  very 


118 


DISEASES 


OtAss  I.  2.  4.  12. 


severe,  passing  from  the  ear  under  the  zygoma  toward  the  nose 
and  mouth,  and  upwards  round  the  orbit.  This  route  proved 
pretty  clearly,  that  the  portio  dura  of  the  auditory  nerve  was  also 
affected;  at  least  the  uppermost  branch  of  the  pes  anserinus.  Be- 
fore I proceded  to  divide  this,  I was  willing  to  try  the  effect  of 
arsenic  internally,  and  he  took  it  in  sufficient  quantity  to  excite 
nausea  and  vertigo,  but  without  perceiving  any  good  effect. 

1 could  now  trust  only  to  the  knife  to  alleviate  his  misery,  as 
the  pain  round  the  orbit  was  become  most  violent;  and  therefore 
intercepted  the  nerve  by  an  incision  across  the  side  of  the  nose, 
and  also  made  some  smaller  incisions  about  the  ala  nasi.  To  di- 
vide the  great  branch  lying  below  the  zygomatic  process,  I found 
it  necessary  to  pass  the  scalpel  through  the  masseter  muscle,  till 
it  came  in  contact  with  the  jaw-bone,  and  then  to  cut  upwards; 
this  relieved  him  as  usual.  Then  the  lower  branch  was  affected, 
and  also  divided:  then  the  middle  branch  running  under  the 
parotid  gland.  In  cutting  this,  the  gland  was  consequently  divid- 
ed into  two  equal  parts,  and  healed  tolerably  well  after  a copious 
discharge  of  saliva  for  several  days. 

I hoped  and  expected,  that  this  last  operation  would  have  ter- 
minated his  sufferings  and  my  difficulties;  but  the  pain  still  af- 
fected the  lower  lip  and  side  of  the  nose,  and  upon  coughing,  or 
swallowing,  his  misery  was  dreadful.  This  pain  could  only  arise 
from  branches  from  the  second  of  the  fifth  pair  passing  into  the 
cheek,  and  lying  between  the  pterygoideus  internus  muscle,  and 
the  upper  part  of  the  lower  jaw.  The  situation  of  this  nerve 
rendered  the  operation  hazardous,  but  after  some  attempts  it  was 
accomplished,  and  this  day  he  set  out  for  Leicestershire  perfectly 
restored. 

I am,  sir,  &c. 

Leigh  Thomas. 

Since  I wrote  the  above,  I have  seen  an  equally  deplorable  and 
instructive  case,  of  hemicrania  idiopathica,  of  an  elderly  person, 
described  by  Dr.  Haighton,  under  the  name  of  tic  douloureux, 
with  an  equally  successful  cure,  by  dividing  the  diseased  nerves. 
Medical  Records  and  Researches.  Cox,  London. 

Two  cases  of  tic  douloureux  are  related  by  a Dr.  Watson,  in 
the  Recueil  Periodique  de  Medecine,  Paris,  1798,  tom.  II  . 
which  are  said  to  have  submitted  to  mercurial  frictions  and  warm 
bathing.  These  pains  were  probably  venereal  symptoms,  as  the 
author  suspects;  but  would  persuade  us  again  to  try  the  use  of 
mercury,  though  it  failed  in  the  case  above  related,  and  especially 
as  it  sometimes  succeeds  in  the  hemicrania  sympathetica,  as  men- 
tioned in  Class  IV.  2.  2,  8.  Five  grains  of  the  powdered  leaf  of 


Ciass  1. 2. 4.  13.  OF  IRRITATION.  119 

belladonna  are  said  to  have  been  successful.  See  Cephalaea 
idiopathica. 

13.  Odontalgia.  Tooth-ach.  The  pain  has  been  erroneously 
supposed,  where  there  is  no  inflammation,  to  be  owing  to  some 
acrid  matter  from  a carious  tooth  stimulating  the  membrane  of 
the  alveolar  process  into  violent  action  and  consequent  pain;  but 
the  effect  seems  to  have  been  mistaken  for  the  cause,  and  the 
decay  of  the  tooth  to  have  been  occasioned  by  the  torpor  and 
consequent  pain  of  the  diseased  membrane. 

First,  because  the  pain  precedes  the  decay  of  the  tooth  in  re- 
gard to  time,  and  is  liable  to  recur,  frequently  for  years,  without 
certainly  being  succeeded  at  last  by  a carious  tooth,  as  I have 
repeatedly  observed. 

Secondly,  because  any  stimulant  drug,  as  pyrethrum,  or  oil  of 
cloves,  applied  to  the  tooth,  or  ether  applied  externally  to  the 
cheek,  is  so  far  from  increasing  the  pain,  as  it  would  do  if  the 
pained  membrane  already  acted  too  strongly,  that  it  frequently 
gives  immediate  relief  like  a charm. 

And  thirdly,  because  the  torpor,  or  deficient  action  of  the 
membrane,  which  includes  the  diseased  tooth,  occasions  the  mo- 
tions of  the  membranes  most  connected  with  it,  as  those  of  the 
cheek  and  temples,  to  act  with  less  than  their  natural  energy; 
and  hence  a coldness  of  the  cheek  is  perceived  easily  by  the  hand 
of  the  patient,  comparing  it  wfith  the  other  cheek;  and  the  pain 
of  hemicrania  is  often  produced  in  the  temple  of  the  affected  side. 

This  coldness  of  the  cheek  in  common  tooth-ach  evinces,  that 
the  pain  is  not  then  caused  by  inflammation;  because  in  all  in- 
flammations so  much  heat  is  produced  in  the  secretions  of  new 
vessels  and  fluids,  as  to  give  heat  to  the  parts  in  the  vicinity. 
And  hence,  as  soon  as  the  gum  swells  and  inflames  along  with 
the  cheek,  heat  is  produced,  and  the  pain  ceases,  owing  to  the 
increased  exertions  of  the  torpid  membrane,  excited  by  the  ac- 
tivity of  the  sensorial  power  of  sensation;  which  previously  ex- 
isted in  its  passive  state  in  the  painful  torpid  membrane.  See 
Odontitis,  Class  II.  1.  4.  7.  and  IV.  2.  2.  8. 

M.  M.  If  the  painful  tooth  be  sound,  venesection.  Then  a 
cathartic.  Afterwards  two  grains  of  opium.  Camphor  and 
opium,  one  grain  of  each  held  in  the  mouth;  or  a drop  or  two  of 
oil  of  cloves  put  on  the  painful  tooth.  Ether.  If  the  tooth  has 
a small  hole  in  it,  this  should  be  widened  within  by  an  instru- 
ment, and  then  stopped  with  leaf-gold,  or  leaf  lead;  but  the  tooth 
should  be  extracted  if  much  decayed.  It  is  probable  that  half  a 
small  drop  of  a strong  solution  of  arsenic,  put  carefully  into  the 
hollow  of  a decayed  aching  tooth,  would  destroy  the  nerve  with- 
out giving  any  additional  pain;  but  this  experiment  requires 


120 


DISEASES 


Class  I.  2.  4.  13. 


great  caution  lest  any  of  the  solution  should  touch  the  tongue  or 
gums. 

Much  cold  and  much  heat  are  equally  injurious  to  the  teeth, 
which  are  endued  with  a fine  sensation  of  this  universal  fluid. 
The  best  method  of  preserving  them  is  by  the  daily  use  of  a 
brush,  which  is  not  very  hard,  with  warm  water  and  fine  char- 
coal dust.  A lump  of  charcoal  should  be  put  a second  time  into 
the  fire  till  it  is  red  hot,  as  soon  as  it  becomes  cool  the  external 
ashes  should  be  blown  off,  and  it  should  be  immediately  reduced 
to  fine  powder  in  a mortar,  and  kept  close  stopped  in  a phial.  It 
takes  away  the  bad  smell  from  decayed  teeth,  by  washing  the 
mouth  with  this  powder  diffused  in  water,  immediately.  The 
putrid  smell  of  decaying  stumps  of  teeth  may  be  destroyed  for  a 
time  by  washing  the  mouth  with  a weak  solution  of  alum  in  wa- 
ter. If  the  calcareous  crust  upon  the  teeth  adheres  very  firmly, 
a fine  powder  of  pumice-stone  may  be  used  occasionally,  or  a 
tooth-instrument. 

Acid  of  sea-salt,  much  diluted,  may  be  used;  but  this  very 
rarely,  and  with  the  greatest  caution,  as  in  cleaning  sea-shells. 
When  the  gums  are  spongy,  they  should  be  frequently  pricked 
with  a lancet.  Should  black  spots  in  teeth  be  cut  out?  Does 
the  enamel  grow  again  when  it  has  been  perforated  or  abraded  ? 

Otalgia.  Ear-ach  sometimes  continues  many  days  without  ap- 
parent inflammation,  and  is  then  frequently  removed  by  filling 
the  ear  with  laudanum,  or  with  ether;  or  even  with  warm  oil, 
or  warm  water.  See  Class  II.  1.4.  S.  This  pain  of  the  ear. 
like  hemicrania,  is  frequently  the  consequence  of  association  with 
a diseased  tooth;  in  that  case  the  ether  should  be  applied  to  the 
cheek  over  the  suspected  tooth;  or  a grain  of  opium  and  as  much 
camphor  mixed  together,  and  applied  to  the  suspected  tooth.  In 
this  case  the  otalgia  belongs  to  the  fourth  class  of  diseases. 

14.  Pleurodyne  chronica.  Chronical  pain  of  the  side.  Pains 
of  the  membranous  parts,  which  are  not  attended  with  fever, 
have  acquired  the  general  name  of  rheumatic;  which  should, 
nevertheless,  be  restricted  to  those  pains  which  exist  only  when 
the  parts  are  in  motion,  and  which  have  been  left  after  inflam- 
mation of  them;  as  described  in  Class  I.  1.  3.  12.  The  pain  of 
the  side  here  mentioned  affects  many  ladies,  and  may  possibly 
have  been  owing  to  the  pressure  of  tight  stays,  which  has  weak- 
ened the  action  of  the  vessels  composing  some  membranous  part, 
as,  like  the  cold  head-ach,  it  it  attended  with  present  debility; 
in  one  patient,  a boy  about  ten  years  old,  it  was  attended  with 
daily  convulsions,  and  was  supposed  to  have  originated  from 
worms.  The  disease  is  very  frequent,  and  generally  withstands 
the  use  of  blisters  on  the  part;  but  in  some  cases  I have  known 


Glass  I.  2.  4. 14. 


OF  IRRITATION. 


121 


it  removed  by  electric  shocks  repeated  every  day  for  a fortnight 
through  the  affected  side. 

Pains  of  the  side  may  be  sometimes  occasioned  by  the  adhe- 
sion of  the  lungs  to  the  pleura,  after  an  inflammation  of  them; 
or  to  the  adhesion  of  some  abdominal  viscera  to  their  cavity,  or 
to  each  other;  which  also  are  more  liable  to  affect  ladies  from 
the  unnatural  and  ungraceful  pressure  of  tight  stays,  or  by  sitting 
or  lying  too  long  tfn  one  posture.  But  in  these  cases  the  pain 
should  be  more  of  the  smarting,  than  of  the  dull  kind. 

M.  M.  Ether.  A blister.  A plaster  of  Burgundy  pitch. 
An  issue  or  seton  on  the  part.  Electric  shocks.  Friction  on 
the  part  with  oil  and  camphor.  Loose  dress.  Frequent  change 
of  posture  both  in  the  day  and  night.  Internally,  opium,  vale- 
rian, bark. 

15.  Sciatica  frigida.  Cold  sciatica.  The  pain  along  the 
course  of  the  sciatic  nerve,  from  the  hip  quite  down  to  the  top  of 
the  foot,  when  it  is  not  attended  with  fever,  is  improperly  termed 
either  rheumatism  or  gout;  as  it  occurs  without  inflammation,  is 
attended  with  pain  when  the  limb  is  at  rest;  and  as  the  pain  at- 
tends the  course  of  the  nerve,  and  not  the  course  of  the  muscles, 
or  of  the  fascia  which  contains  them.  The  theory  of  Cotunnius, 
who  believed  it  to  be  a dropsy  of  the  sheath  of  the  nerve,  which 
was  compressed  by  the  accumulated  fluid,  has  not  been  confirm- 
ed by  dissection.  The  disease  seems  to  consist  of  a torpor  of 
this  sheath  of  the  nerve;  and  the  pain  seems  to  be  in  consequence 
of  this  torpor.  See  Class  II.  1.  2.  17. 

M.  M.  Venesection.  A cathartic.  And  then  one  grain  of 
calomel  and  one  of  opium  every  night  for  ten  successive  nights. 
And  a blister  at  the  same  time,  a little  above  the  knee-joint  on 
the  outside  of  the  thigh,  where  the  sciatic  nerve  is  not  so  deep 
seated.  Warm  bath.  Cold  bath.  Cover  the  limb  with  oiled 
silk,  or  with  a plaster  bandage  of  emplastrum  de  minio. 

16.  Lumbago  frigida.  Cold  lumbago.  When  no  fever  or 
inflammation  attends  this  pain  of  the  loins,  and  the  pain  exists 
without  motion,  it  belongs  to  this  genus  of  diseases,  and  resem- 
bles the  pain  of  the  loins  in  the  cold  fit  of  ague.  As  these  mem- 
branes are  extensive,  and  more  easily  fall  into  quiescence,  either 
by  sympathy,  or  when  they  are  primarily  affected,  this  disease  be- 
comes  very  afflicting,  and  of  great  pertinacity.  See  Class  II.  1. 
2.  17. 

M.  M.  Venesection.  A cathartic.  Issues  on  the  loins. 
Adhesive  plaster  on  the  loins.  Blister  on  the  os  sacrum.  Warm 
bath.  Cold  bath.  Remove  to  a warmer  climate  in  the  winter. 
Loose  dress  about  the  waist.  Friction  daily  with  oil  and  cam- 
phor. 

VOL  II. 


R 


123 


DISEASES 


Class  I.  2.  4.  IT. 


17.  IJysteralgia  frigida.  Cold  pain  of  the  uterus  preceding  or 
accompanying  menstruation.  It  is  attended  with  cold  extremi- 
ties, want  of  appetite,  and  other  marks  of  general  debility. 

M.  M.  A clyster  of  half  a pint  of  gruel,  and  30  drops  of  lau- 
danum; or  a grain  of  opium  and  six  grains  of  rhubarb  every  night 
To  sit  over  warm  water,  or  go  into  a warm  bath. 

18.  Proctalgia  frigida.  Cold  pain  at  the  bottom  of  the  rec- 
tum previous  to  the  tumor  of  the  piles,  which  sometimes  extends 
by  sympathy  to  the  loins;  it  seems  to  be  similar  to  the  pain  at 
the  beginning  of  menstruation,  and  is  owing  to  the  torpor  or  inir- 
ritability of  the  extremity  of  the  alimentary  canal,  or  to  the  ob- 
struction of  the  blood  in  its  passage  through  the  liver,  when 
that  viscus  is  affected,  and  its  consequent  delay  in  the  veins  of 
the  rectum,  occasioning  tumours  of  them,  and  dull  sensations  of 
pain. 

M.  M.  Calomel.  A cathartic.  Spice.  Clyster,  with  30 
drops  of  laudanum.  Sitting  over  warm  water.  If  chalybeates 
after  evacuation?  See  Class  I.  2.  3.  23.  and  I.  2.  1.  6. 

19.  VesiccB  fellecc  inirritabilitas.  The  inirritability  of  the  gall- 
bladder probably  occasions  one  kind  of  ictems , or  jaundice; 
which  is  owing  to  wdiatever  obstructs  the  passage  of  bile  into 
the  duodenum.  The  jaundice  of  aged  people,  and  w hich  attends 
some  fevers,  is  believed  to  be  most  frequently  caused  by  an  irri- 
tative palsy  of  the  gall-bladder;  on  which  account  the  bile  is 
not  pressed  from  the  cyst  by  its  contraction,  as  in  a paralysis  of 
the  urinary  bladder. 

A thickening  of  the  coats  of  the  common  bile-duct  by  inflam- 
mation or  increased  action  of  their  vessels  so  as  to  prevent  the 
passage  of  the  bile  into  the  intestine,  in  the  same  manner  as  the 
membrane  which  lines  the  nostrils,  becomes  thickened  in  ca- 
tarrh so  as  to  prevent  the  passage  of  air  through  them,  is  proba- 
bly another  frequent  cause  of  jaundice,  especially  of  children: 
and  generally  ceases  in  about  a fortnight,  like  a common  catarrh, 
without  the  aid  of  medicine;  which  has  given  rise  to  the  charac- 
ter, which  charms  have  obtained  in  some  countries  for  curing  the 
jaundice  of  young  people. 

The  spissitude  of  the  bile  is  another  cause  of  jaundice,  as  men- 
tioned in  Class  I.  1.3.  8.  This  also  in  children  is  a disease  of 
little  danger,  as  the  gall-ducts  are  distensible,  and  will  the  easier 
admit  of  the  exclusion  of  gall-stones;  but  becomes  a more  seri- 
ous disease  in  proportion  to  the  age  of  the  patient,  and  his  habits 
of  life  in  respect  to  spirituous  potation. 

A fourth  cause  of  jaundice  is  the  compression  of  the  bile-duct 
by  the  enlargement  of  an  inflamed  or  scirrhous  liver;  this  attends 


OF  IRRITATION. 


Class  r.  2.  4.  20. 


123 


those  who  have  drunk  much  spirituous  liquor,  and  is  generally 
succeeded  by  dropsy  and  death. 

M.  M.  Repeated  emetics.  Mild  cathartics.  Warm  bath. 
Electricity.  Bitters.  Then  steel,  which,  when  the  pain  and 
inflammation  are  removed  by  evacuations,  acts  like  a charm  in 
removing  the  remainder  of  the  inflammation,  and  by  promoting 
the  absorption  of  the  new  vessels  or  fluids;  like  the  application 
of  any  acrid  eye-water  at  the  end  of  ophthalmia;  and  thus  the 
thickened  coats  of  the  bile-duct  become  reduced,  or  the  enlarge- 
ment of  the  liver  lessened,  and  a free  passage  is  again  opened  for 
the  bile  into  the  intestine.  Ether  with  yolk  of  egg  is  recom- 
mended, as  having  a tendency  to  dissolve  inspissated  bile.  And 
a decoction  of  madder  is  recommended  for  the  same  purpose; 
because  the  bill  of  animals,  whose  food  was  mixed  with  madder, 
was  found  always  in  a dilute  state.  Aerated  alkaline  water,  or 
Seltzer  water.  Raw  cabbage,  and  other  acrid  vegetables,  as 
water-cresses,  mustard.  Horses  are  said  to  be  subject  to  in- 
spissated bile,  with  yellow  eyes,  in  the  winter  season,  and  to  get 
well  as  soon  as  they  feed  on  the  spring  grass. 

The  largest  bile-stone  I have  seen  was  from  a lady,  w’ho  had 
parted  with  it  some  years  before,  and  who  had  abstained  above 
ten  years  from  all  kinds  of  vegetable  diet  to  prevent,  as  she 
supposed,  a cholic  of  her  stomach,  which  was  probably  a pain 
of  the  biliary  duct;  on  resuming  the  use  of  some  vegetable  diet, 
she  recovered  a better  state  of  health,  and  formed  no  new  bilious 
concretions. 

A strong  aerated  alkaline  water  is  sold  by  J.  Schweppe,  No.  8, 
King-street,  Holborn.  See  Class  I.  1.3.  10. 

20.  Pelvis  renalis  inirritabilitas.  Inirritability  of  the  pelvis  of 
the  kidney.  When  the  nucleus  of  a stone,  whether  it  be  in- 
spissated mucus,  or  other  matter,  is  formed  in  the  extremity  of 
any  of  the  tubuli  uriniferi,  and  being  detached  from  thence  falls 
into  the  pelvis  of  the  kidney,  it  is  liable  to  lodge  there  from  the 
want  of  due  irritability  of  the  membrane;  and  in  that  situation 
increases  by  new’  appositions  of  indurated  animal  matter,  in  the 
same  manner  as  the  stone  of  the  bladder.  This  is  the  general 
cause  of  hasmorrhage  from  the  kidney;  and  of  obtuse  pain  in  it 
on  exercise;  or  of  acute  pain  when  the  stone  advances  into  the 
ureter.  See  Class  I.  1.3.  9. 


124 


DISEASES 


Class  I.  2.  5.  1. 


ORDO  II. 

Decreased  Irritation. 

GENUS  V. 

Decreased  Action  of  the  Organs  of  Sense,. 

SPECIES. 

1.  Stultitiainirritabilitas.  Folly  from  inirritability.  Duluess 
of  perception.  When  the  motions  of  the  fibrous  extremities  of 
the  nerves  of  sense  are  too  weak,  to  excite  sensation  with  suf- 
ficient quickness  and  vigour.  The  irritative  ideas  are  neverthe- 
less performed,  though  perhaps  in  a feeble  manner,  as  such  peo- 
ple do  not  run  against  a post,  or  walk  into  a well.  There  are 
three  other  kinds  of  folly;  that  from  deficient  sensation,  from 
deficient  volition,  and  from  deficient  association,  as  will  be  men- 
tioned in  their  places.  In  delirium,  reverie,  and  sleep,  the 
power  of  perception  is  abolished  from  other  causes. 

2.  Viscus  imminutus.  Diminished  vision.  In  our  approach  to 
old  age  our  vision  becomes  imperfect,  not  only  from  the  form  of 
the  cornea,  which  becomes  less  convex,  and  from  its  decreased 
transparency  mentioned  in  Class  I.  1.  3.  14;  but  also  from  the 
decreased  irritability  of  the  optic  nerve.  Thus,  in  the  inirritative 
or  nervous  fever,  the  pupil  of  the  eye  becomes  dilated;  which  in 
this,  as  well  as  in  the  dropsy  of  the  brain,  is  generally  a fatal 
symptom.  A part  of  the  cornea  as  well  as  a part  of  the  albugi- 
nea in  these  fevers  is  frequently  seen  during  sleep;  which  is 
owing  to  the  inirritability  of  the  retina  to  light,  or  to  the  gene- 
ral paresis  of  muscular  action,  and  in  consequence  to  the  less 
contraction  of  the  sphincter  of  the  eye,  if  it  may  be  so  called,  at 
that  time. 

In  some  eyes  there  is  an  inaptitude  to  adapt  themselves  to 
the  perception  of  objects  at  different  distances,  which  I suppose 
may  be  owing  to  the  inirritability  of  those  muscular  fibres,  which 
constitute  the  ciliary  process,  so  wrell  described  and  explained  by 
Dr.  Porterfield,  and  in  the  Scots  Medical  Essays,  and  so  elegant- 
ly seen  in  a dissected  eye.  It  was  formerly  believed,  and  has  in- 
deed lately  been  again  pretended,  that  the  focus  of  the  crystal- 
line humour  was  adapted  to  objects  at  different  distances  by  a 
change  of  the  shape  of  the  whole  eye  by  the  action  of  the  exter- 
nal muscles,  which  are  inserted  into  the  tunica  albuginea,  and 
give  motion  to  it  in  every  direction;  but  in  answer  to  this  may  be 


Class  I.  2.  5.  3. 


OF  IRRITATION. 


125 


observed,  that  if  the  common  actions  of  the  muscles  affected  the 
focus  of  the  eye,  every  motion  of  the  eye-ball,  when  we  attend 
to  objects  at  any  distance,  must  disturb  our  vision.  At  the  same 
time  though  it  is  possible  that  a violent  action  of  all  the  muscles 
together,  so  as  to  counterbalance  each  other,  and  keep  the  eye 
motionless,  as  when  we  look  painfully  at  a very  distant  object, 
may  in  some  degree  affect  the  form  of  it;  yet  that  the  contrac- 
tion of  the  ciliary  process  perpetually  adapts  the  focus  of  the  crys- 
talline lens  to  the  distance  of  the  retina  is  not  to  be  disputed. 

There  have  been  instances  of  some,  who  could  not  distinguish 
certain  colours;  and  yet  whose  eyes,  in  other  respects,  were  not 
imperfect.  Philos.  Transact.  Which  seems  to  have  been 
owing  to  the  want  of  irritability,  or  the  inaptitude  to  action,  of 
some  classes  of  fibres  which  compose  the  retina.  Other  perma- 
nent defects  depend  on  the  diseased  state  of  the  external  organ. 
Class  I.  1.  3.  14.  1.2.2.13.  IV.  2.  1.  11. 

3.  Muscce,  volitantes.  Dark  spots  appearing  before  the  eyes, 
and  changing  their  apparent  place  with  the  motions  of  the  eyes, 
are  owing  to  a temporary  defect  of  irritability  of  those  parts  of 
the  retina,  which  have  been  lately  exposed  to  more  luminous  ob- 
jects than  the  other  parts  of  it,  as  explained  in  Sect.  XL.  2. 
Hence  dark  spots  are  seen  on  the  bed-clothes  by  patients,  when 
the  optic  nerve  is  become  less  irritable,  as  in  fevers  with  great 
debility;  and  the  patients  are  perpetually  trying  to  pick  them  off 
with  their  fingers  to  discover  what  they  are;  for  these  parts  of 
the  retina  of  weak  people  are  sooner  exhausted  by  the  stimulus 
of  bright  colours,  and  are  longer  in  regaining  their  irritability. 

Other  kinds  of  ocular  spectra,  as  the  coloured  Ones,  are  also 
more  liable  to  remain  in  the  eyes  of  people  debilitated  by  fevers, 
and  to  produce  various  hallucinations  of  sight.  For  after  the 
contraction  of  a muscle,  the  fibres  of  it  continue  in  the  last  situa- 
tion, till  some  antagonist  muscles  are  exerted  to  retract  them; 
whence,  when  any  one  is  much  exhausted  by  exercise,  or  by  want 
of  sleep,  or  in  fevers,  it  is  easier  to  let  the  fibres  of  the  retina  re- 
main in  their  last  situation,  after  having  been  stimulated  into 
contraction,  than  to  exert  any  antagonist  fibres  to  replace  them. 

As  the  optic  nerves  at  their  entrance  into  the  eyes  are  each  of 
them  as  thick  as  a crow-quill,  it  appears  that  a great  quantity  of 
sensorial  power  is  expended  during  the  clay  in  the  perpetual  ac- 
tivity of  our  sense  of  vision,  besides  that  used  in  the  motions  of 
the  eye-balls  and  eye-lids;  as  much  I suppose  as  is  expended  in 
the  motions  of  our  arms,  which  are  supplied  with  nerves  of 
about  the  same  diameters.  From  hence  we  may  conclude,  that 
the  light  should  be  kept  from  patients  in  fevers  with  debility,  to 
prevent  the  unnecessary  exhaustion  of  the  sensorial  power. 


126 


DISEASES 


Class  I.  2.  5.  4. 


And  that  on  the  same  account  their  rooms  should  be  kept  silent 
as  well  as  dark;  that  they  should  be  at  rest  in  a horizontal  pos- 
ture; and  be  cooled  by  a blast  of  cool  air,  or  by  washing  them 
with  cold  water,  whenever  their  skins  are  warmer  than  natural. 

4.  Strabismus.  Squinting  is  generally  owing  to  one  eye  be- 
ing less  perfect  than  the  other;  on  which  account  the  patient 
endeavours  to  hide  the  worst  eye  in  the  shadow  of  the  nose,  that 
his  vision  by  the  other  may  not  be  confused.  Calves  which 
have  an  hydatide  with  insects  inclosed  in  it  in  the  frontal  sinus 
on  one  side,  turn  towards  the  affected  side;  because  the  vision 
on  that  side,  by  the  pressure  of  the  hydatide,  becomes  less  per- 
fect; and  the  disease  being  recent,  the  animal  turns  round,'  ex- 
pecting to  get  a more  distinct  view  of  objects. 

In  the  hydrocephalus  internus,  where  both  eyes  are  not  be- 
come insensible,  the  patient  squints  with  only  one  eye,  and  views 
objects  with  the  other,  as  in  common  strabismus.  In  this  case 
it  may  be  known  on  which  side  the  disease  exists,  and  that  it 
does  not  exist  on  both  sides  of  the  brain;  in  such  circumstances, 
as  the  patients  I believe  never  recover  as  they  are  now  treated, 
might  it  not  be  adviseable  to  perforate  the  cranium  over  the  ven- 
tricule  of  the  affected  side?  which  might  at  least  give  room  and 
stimulus  to  the  affected  part  of  the  brain? 

M.  M.  If  the  squinting  has  not  been  confirmed  by  long  habit, 
and  one  eye  be  not  much  worse  than  the  other,  a piece  of  gauze 
stretched  on  a circle  of  whale-bone,  to  cover  the  best  eye  in 
such  a manner  as  to  reduce  the  distinctness  of  vision  of  this  eye  to 
a similar  degree  of  imperfection  with  the  other,  should  be  worn 
some  hours  every  day.  Or  the  better  eye  should  be  totally 
darkened  by  a tin  cup  covered  with  black  silk  for  some  hours 
daily,  by  which  means  the  better  eye  will  be  gradually  weaken- 
ed by  the  want  of  use,  and  the  worse  eye  will  be  gradually 
strengthened  by  using  it.  Covering  an  inflamed  eye  in  children 
for  weeks  together,  is  very  liable  to  produce  squinting,  for  the 
same  reason. 

5.  Jlmaurosis.  Gutta  serena.  Is  a blindness  from  the  inirrita- 
bility  of  the  optic  nerve.  It  is  generally  esteemed  a palsy  of  the 
nerve,  but  should  rather  be  deemed  the  death  of  it,  as  paralysis  has 
generally  been  applied  to  deprivation  only  of  voluntary  power. 
This  is  a disease  of  dark  eyes  only,  as  the  cataract  is  a disease  of 
light  eyes  only.  At  the  commencement  of  this  disease,  very  minute 
electric  shocks  should  be  repeatedly  passed  through  the  eyes;  such 
as  may  be  produced  by  putting  one  edge  of  a piece  of  silver  the 
size  of  a half  crown  piece  beneath  the  tongue,  and  one  edge  of  a 
piece  of  zinc  of  a similar  size  between  the  upper  lip  and  the  gum. 


Glass  I.  2.  5.  6. 


OF  IRRITATION. 


HI 


and  then  repeatedly  bringing  their  exterior  edges  into  contact, 
by  which  means  very  small  electric  sparks  become  visible  in  the 
eyes. 

Mrs.  T had  for  some  weeks  complained  of  imperfect 

sight.  For  the  last  fortnight  she  could  not  in  less  than  a minute 
spell  out  a single  word  in  a large  print.  Her  eyes  black,  and  the 
pupils  large  Very  slight  electric  shocks,  not  sparks,  w’ere  passed 
through  the  forepart  of  her  forehead  twice  a day,  and  the  zinc 
and  silver  pencils  as  mentioned  below  were  used  many  times  a 
day.  She  took  valerian  and  columbo  internally,  and  regained 
her  sight  very  perfectly  in  about  three  weeks. 

I used  in  the  above  case  a more  convenient  and  efficacious 
method  of  galvanism  by  employing  two  rods,  one  of  them  of  zinc 
about  the  size  of  a writing  pencil,  and  the  other  a silver  pencil- 
case  about  the  same  size;  and  by  putting  the  end  of  the  zinc 
rod  in  contact  with  the  external  corner  of  one  eye,  and  the  end 
of  the  silver  pencil-case  in  contact  with  the  external  corner  of 
the  other  eye,  and  then  repeatedly  making  the  other  ends  touch 
each  other,  sparks  will  be  visible  in  the  eyes  both  at  the  time  of 
contact  and  at  the  time  of  separation  of  the  two  rods.  This  ex- 
periment was  published  by  Volta  since  the  former  one  by  Gal- 
vani.  See  Sect.  XIV.  5.  of  Vol.  I. 

A foreign  physician,  professor  Arneman,  has  lately  recom- 
mended the  production  of  vertigo  in  gutta  serena,  as  he  says,  to 
accumulate  more  blood  in  the  head.  If  this  should  be  really 
found  of  advantage,  the  patient  might  lie  on  a large  mill-stone, 
which  might  be  suffered  to  turn  slowly,  but  a very  great  velocity 
of  the  whirling  stone  might  occasion  sleep,  apoplexy,  and  death. 
See  Suppl.  I.  15.  7. 

M.  M.  Minute  electric  shocks.  A grain  of  opium,  and  a 
quarter  of  a grain  of  corrosive  sublimate  of  mercury,  twice  a day 
for  four  or  six  weeks.  Blister  on  the  crown  of  the  head.  Er- 
rhines,  so  as  to  induce  violent  sneezing  twice  a day  for  a week. 

6.  Audit  us  imminutus.  Diminished  hearing.  Deafness  is  a 
frequent  symptom  in  those  inflammatory  or  sensitive  fevers  with 
debility,  which  are  generally  called  putrid;  it  attends  the  general 
stupor  in  those  fevers,  and  is  rather  esteemed  a salutary  sign,  as 
during  this  stupor  there  is  less  expenditure  of  sensorial  power. 

In  fevers  of  debility  without  inflammation,  called  nervous  fe- 
vers, I suspect  deafness  to  be  a bad  symptom,  arising,  like  the  di- 
lated pupil,  from  a partial  paralysis  of  the  nerve  of  sense.  See 
Class  IV.  2.  1.15. 

Nervous  fevers  are  supposed  by  Dr.  Gilchrist  to  originate  from 
a congestion  of  serum  or  water  in  some  part  of  the  brain,  as  many 
of  the  symptoms  are  so  similar  to  those  of  hydrocephalus  inter- 


128 


DISEASES 


Class  I.  2.  5.  6. 


nus,  in  which  a fluid  is  accumulated  in  the  ventricles  of  the 
brain;  on  this  idea  the  inactivity  of  the  optic  or  auditory  nerves 
in  these  fevers  may  arise  from  the  compression  of  the  effused  fluid, 
while  the  torpor  attending  putrid  fever  may  depend  on  the  me- 
ninges of  the  brain  being  thickened  by  inflammation,  and  thus 
compressing  it;  now  the  new  vessels,  or  the  blood,  which  thickens 
inflamed  parts,  is  more  frequently  reabsorbed,  than  the  effused 
fluid  from  a cavity;  and  hence  the  stupor  in  one  case  is  less  dan- 
gerous than  in  the  other. 

In  inflammatory  or  sensitive  fevers  with  debility,  deafness  may 
sometimes  arise  from  a greater  secretion  and  absorption  of  the 
ear-wax,  which  is  very  similar  to  the  bile,  and  is  liable  to  fill  the 
meatus  auditorius,  when  it  is  too  viscid,  as  bile  obstructs  the 
gall-ducts. 

M.  M.  In  deafness  without  fever,  Dr.  Darwin  applied  a cup- 
ping-glass on  the  ear  with  good  effect,  as  described  in  Phil. 
Trans.  Vol.  LXIY.  p.  348.  Oil,  ether,  laudanum,  dropped  into 
the  ears.  Errhines.  Electricity. 

If  ether  when  dropped  into  the  ears  be  not  very  pure,  it  is  liable 
to  give  pain;  it  has  otherwise  the  property  both  of  dissolving  the 
ear-wax,  and  of  stimulating  torpid  parts  into  their  accustomed 
activity,  as  is  known  from  its  relieving  pains  from  inactivity  of 
the  pained  part,  as  tooth-ach  and  head-ach.  If  unrectified  ether 
be  distilled  from  the  oxyde  of  manganese,  the  oxygen  disengaged 
from  the  manganese  is  asserted  to  convert  the  sulphurous  into 
sulphuric  acid,  which  is  then  not  disposed  to  rise  in  distillation. 
Journal  de  Physique,  April,  1798.  And  that  this  is  the  great 
secret  of  procuring  pure  ether,  and  it  will  then  give  no  pain  on 
being  dropped  into  the  ear.  See  Art.  II.  2.  3. 

Deafness  is  believed  sometimes  to  arise  from  obstruction  of  the 
Eustachian  tubes,  which  communicate  from  the  fauces  to  the  in- 
ternal ear  behind  the  tympanum;  if  this  obstruction  be  slight,  as 
by  inspissated  mucus,  it  has  been  proposed  to  inject  the  Eusta- 
chian tubes;  and  it  is  said,  that  if  the  deaf  person  frequently 
has  recourse  to  the  simple  action  of  shutting  his  mouth  and  of 
closing  his  nostrils  by  pinching  them  together  w’ith  his  finger  and 
thumb,  and  then  forcibly  endeavours  to  press  the  breath  through 
his  nose,  that  air  will  pass  into  the  internal  ear  through  the  Eus- 
tachian tubes,  condensing  that  air  which  exists  behind  the  tym- 
panum; which  the  patient  will  himself  be  sensible  of,  by  a sen- 
sation of  sound  in  his  ears.  And  that  this  has  relieved  many. 

Where  an  eruption  occurs  in  the  ear,  followed  by  a dry  scale 
or  scab  at  the  bottom  of  the  meatus  auditorius,  a solution  of 
corrosive  sublimate  of  mercury,  hydrargyrus  muriatus,  about  one 
grain  to  an  ounce  of  water,  dropped  into  the  ear,  frequently  has 


OP  IRRITATION. 


Glass  I.  2.  S.  7. 


129 


been  used  with  advantage  by  Dr.  Darwin  of  Shrewsbury.  See 
Class  IY.  2.  1.  15. 

7.  Olfactus  imminutus.  Inactivity  of  the  sense  of  smell. 
From  our  habits  of  trusting  to  the  art  of  cookery,  and  not  exa- 
mining our  food  by  the  smell  as  other  animals  do,  our  sense  of 
smell  is  less  perfect  than  theirs.  See  Sect.  XYI.  5.  Class  IV. 
2.  1.  16. 

M.  M.  Mild  errhines. 

8.  Gustus  imminutus.  Want  of  taste  is  very  common  in  fevers, 
owing  frequently  to  the  dryness  or  scurf  of  the  tongue,  or  exter- 
nal organ  ofthat  sense,  rather  than  to  any  injury  of  the  nerves  of 
taste.  See  Class  I.  1.  3.  1.  IY.  2.  1.  16. 

M.  M.  Warm  subacid  liquids  taken  frequently. 

9.  Tactus  imminutus.  Numbness  is  frequently  complained  of 
in  fevers  and  in  epilepsy,  and  the  touch  is  sometimes  impaired 
by  the  dryness  of  the  cuticle  of  the  fingers.  See  Class  IV.  2.  1.  16. 

* When  the  sense  of  touch  is  impaired  by  the  compression  of  the 
nerve,  as  in  sitting  long  with  one  thigh  crossed  over  the  other, 
the  limb  appears  larger,  when  we  touch  it  with  our  hands, 
which  is  to  be  ascribed  to  the  indistinctness  of  the  sensation  of 
touch,  and  may  be  explained  in  the  same  manner  as  the  appa- 
rent largeness  of  objects  seen  through  a mist.  In  this  last  case 
the  minute  parts  of  an  object,  as  suppose  of  a distant  boy,  are 
seen  less  distinctly,  and  therefore  we  instantly  conceive  them  to 
be  further  from  the  eye,  and  in  consequence  that  the  whole  sub- 
tends a larger  angle,  and  thus  we  believe  the  boy  to  be  a man. 
So  when  ariy  one’s  fingers  are  pressed  on  a benumbed  limb,  the 
sensation  produced  is  less  than  it  should  be,  judging  from  visible 
circumstances;  we  therefore  conceive,  that  something  intervened 
between  the  object  and  the  sense,  for  it  is  felt  as  if  a blanket  was 
put  between  them;  and  that  not  being  visibly  the  case,  we  judge 
that  the  limb  is  swelled. 

The  sense  of  touch  is  also  liable  to  be  deceived  from  the  ac- 
quired habits  of  one  part  of  it  acting  in  the  vicinity  of  another 
part  of  it.  Thus  if  the  middle  finger  be  crossed  over  either  of 
the  fingers  next  to  it,  and  a nut  be  felt  by  the  two  ends  of  the 
fingers  so  crossed  at  the  same  time,  the  nut  appears  as  if  it  was 
two  nuts.  And  lastly,  the  sense  of  touch  is  liable  to  be  deceived 
by  preconceived  ideas;  which  we  believe  to  be  excited  by  exter- 
nal objects,  even  when  we  are  awake.  It  has  happened  to  me 
more  than  once,  and  I suppose  to  most  others,  to  have  put  my 
hands  into  an  empty  bason,  standing  in  an  obscure  corner  of  a 
room,  to  wash  them,  which  I believed  to  contain  cold  water,  and 
have  instantly  perceived  a sensation  of  warmth,  contrary  to  that 
which  I expected  to  have  felt. 

von.  n. 


s 


130 


DISEASES 


Class  I.  2.  5. 10, 


In  some  paralytic  affections,  and  in  cold  fits  of  ague,  the  sensa- 
tion of  touch  has  been  much  impaired,  and  yet  that  of  heat  has 
remained.  See  Sect.  XIV.  6. 

M.  M.  Friction  alone,  or  with  camphorated  oil,  warm  bath. 
Ether.  Volatile  alkali  and  water.  Internally,  spice,  salt.  In- 
citentia.  Secernentia. 

10.  Stupor.  The  stupor,  which  occurs  in  fevers  with  debi- 
lity, is  generally  esteemed  a favourable  symptom;  which  may 
arise  from  the  less  expenditure  of  sensorial  power  already  exist  ing 
in  the  brain  and  nerves,  as  mentioned  in  species  6 of  this  genus. 
But  if  we  suppose,  that  there  is  a continued  production  of  senso- 
rial power,  or  an  accumulation  of  it  in  the  torpid  parts  of  the  sys- 
tem, which  is  not  improbable,  because  such  a production  of  it 
continues  during  sleep,  to  which  stupor  is  much  allied,  there  is 
still  further  reason  for  believing  it  to  be  a favourable  symptom  in 
inirritable  fevers;  and  that  much  injury  is  often  done  by  blisters 
and  other  powerful  stimuli  to  remove  the  stupor.  See  Sect.  XII 
7.  8.  and  XXXIII.  1.  4. 

Dr.  Blane,  in  his  Croonian  Lecture  on  muscular  motion,  for 
1 788,  among  many  other  ingenious  observations  and  deductions, 
relates  a curious  experiment  on  salmon,  and  other  fish,  and  which 
he  repeated  upon  eels  with  similar  event. 

“ If  a fish,  immediately  upon  being  taken  out  of  the  water, 
is  stunned  by  a violent  blow  on  the  head,  or  by  having  the  head 
crushed,  the  irritability  and  sweetness  of  the  muscles  will  be  pre- 
served much  longer,  than  if  it  had  been  allowed  to  die  with  the 
organs  of  sense  entire.  This  is  so  well  known  to  fishermen, 
that  they  put  it  in  practice,  in  order  to  make  them  longer  suscep- 
tible of  the  operation  called  crimping.  A salmon  is  one  of  the 
fish  least  tenacious  of  life,  insomuch,  that  it  will  lose  all  signs  of 
life  in  less  than  half  an  hour  after  it  is  taken  out  of  the  w ater,  if 
suffered  to  die  without  any  farther  injury;  but  if,  immediately  af- 
ter being  caught,  it  receives  a violent  blow  on  the  head,  the 
muscles  will  shew  visible  irritability  for  more  than  twelve  hours 
afterwards.” 

Dr.  Blane  afterwards  well  remarks,  that,  “ in  those  disorders 
in  which  the  exercise  of  the  senses  is  in  a great  measure  destroy- 
ed or  suspended,  as  in  the  hydrocephalus,  and  apoplectic  palsy, 
it  happens,  not  uncommonly,  that  the  appetite  and  digestion  are 
better  than  in  health.” 


Class  I.  3. 1. 


OF  IRRITATION. 


131 


ORDO  III. 

Retrograde  Irritative  Motions. 

GENUS  I. 

Of  the  Alimentary  Canal. 

The  retrograde  motions  of  our  system  originate  either  from 
defect  of  stimulus,  or  from  defect  of  irritability.  Thus  sickness 
is  often  induced  by  hunger,  which  is  a want  of  stimulus;  and 
from  ipecacuanha,  in  which  last  case  it  would  seem,  that  the 
sickness  was  induced  after  the  violence  of  the  stimulus  was  abat- 
ed, and  the  consequent  torpor  had  succeeded.  Hence,  spice, 
opium,  or  food,  relieves  sickness. 

The  globus  hystericus,  salivation,  diabetes,  and  other  inver- 
sions of  motion  attending  hysteric  paroxysms,  seem  to  depend  on 
the  want  of  irritability  of  those  parts  of  the  body,  because  they 
are  attended  with  cold  extremities,  and  general  debility,  and  are 
relieved  by  wine,  opium,  steel,  and  flesh  diet;  that  is,  by  any  ad- 
ditional stimulus. 

When  the  longitudinal  muscles  are  fatigued  by  long  action,  or 
are  habitually  weaker  than  natural,  the  antagonist  muscles  re- 
place the  limb  by  stretching  it  in  a contrary  direction;  and  as 
these  muscles  have  had  their  actions  associated  in  synchronous 
tribes,  their  actions  cease  together.  But  as  the  hollow  muscles 
propel  the  fluids,  which  they  contain,  by  motions  associated  in 
trains;  when  one  ring  is  fatigued  from  its  too  great  debility,  and 
brought  into  retrograde  action;  the  next  ring,  and  the  next, 
from  its  association  in  train  falls  into  retrograde  action.  Which 
continue  so  long  as  they  are  excited  to  act,  like  the  tremors  of 
the  hands  of  infirm  people,  so  long  as  they  endeavour  to  act. 
Now  as  these  hollow  muscles  are  perpetually  stimulated,  these 
retrograde  actions  do  not  cease  as  the  tremors  of  the  longitudi- 
nal muscles,  which  are  generally  excited  only  by  volition. 
Whence  the  retrograde  motions  of  hollow  muscles  depend  on 
two  circumstances,  in  which  they  differ  from  the  longitudinal 
muscles,  namely,  their  motions  being  associated  in  trains,  and 
their  being  subject  to  perpetual  stimulus.  For  further  elucida- 
tion of  the  cause  of  this  curious  source  of  diseases,  see  Sect. 
XXIX.  11.  5. 

The  fluids  disgorged  by  the  retrograde  motions  of  the  various 
vascular  muscles  may  be  distinguished,  1.  From  those  which 
are  produced  by  secretion,  by  their  not  being  attended  by  increase 


132 


DISEASES 


Class  I.  3.  1.  1. 


of  heat,  which  always  accompanies  increased  secretion.  2.  They 
may  be  distinguished  from  those  fluids,  which  are  the  consequence 
of  deficient  absorption,  by  their  not  possessing  the  saline  acrimony, 
which  those  fluids  possess;  which  inflames  the  skin  or  other  mem- 
branes on  which  they  fall;  and  which  have  a saline  taste  to  the 
tongue.  3.  They  may  be  distinguished  from  those  fluids,  which 
are  the  consequence  both  of  increased  secretion  and  absorption,  as 
these  are  attended  with  increase  of  warmth,  and  are  inspissated 
by  the  abstraction  of  their  aqueous  parts.  4.  Where  chyle,  or 
milk,  is  found  in  the  feces  or  urine,  or  when  other  fluids,  as  mat- 
ter, arc  translated  from  one  part  of  the  system  to  another,  they 
have  been  the  product  of  retrograde  action  of  lymphatic  or  other 
canals.  As  explained  in  Sect.  XXIX.  8. 

SPECIES. 

1.  Rumimtio.  In  the  rumination  of  horned  cattle  the  retro- 
grade motions  of  the  oesophagus  are  visible  to  the  eye,  as  they 
bring  up  the  softened  grass  from  their  first  stomach.  The  vege- 
table aliment  in  the  first  stomach  of  cattle,  which  have  filled 
themselves  too  full  of  young  clover,  is  liable  to  run  into  fermenta- 
tion, and  distend  the  stomach,  so  as  to  preclude  its  exit,  and 
frequently  to  destroy  the  animal.  To  discharge  this  air  the 
farmers  frequently  make  an  opening  into  the  stomach  of  the 
animal  with  success.  I w'as  informed,  I believe  by  the  late  Dr. 
Wrhytt  of  Edinburgh,  that  of  twenty  cows  in  this  situation  two 
had  died,  and  that  he  directed  a pint  of  gin  or  whiskey,  mixed 
with  an  equal  quantity  of  water,  to  be  given  to  the  other  eigh- 
teen; all  of  which  eructed  immense  quantities  of  air,  and  re- 
covered. 

There  are  histories  of  ruminating  men,  and  who  have  taken 
pleasure  in  the  act  of  chewing  their  food  a second  time.  Philos. 
Transact. 

2.  Ructus.  Eructation.  An  inverted  motion  of  the  stomach 
excluding  through  its  upper  valve  an  elastic  vapour,  generated 
by  the  fermentation  of  the  aliment;  which  proceeds  so  hastily, 
that  the  digestive  power  does  not  subdue  it.  This  is  sometimes 
acquired  by  habit, so  that  some  people  can  eruct  when  they  please, 
and  as  long  as  they  please;  and  there  is  gas  enough  generated 
to  supply  them  for  this  purpose;  for  by  Dr.  Hale’s  experiments, 
an  apple,  and  many  other  kinds  of  aliment,  give  up  above  six 
hundred  times  their  own  bulk  of  an  elastic  gas  in  fermentation. 
W^hen  people  voluntarily  eject  the  fixable  air  from  their  sto- 
mach, the  fermentation  of  the  aliment  proceeds  the  faster;  for 
stopping  the  vessels,  which  contain  new  wines,  retards  their  fer- 


Class  I.  3.  1.  3, 


OF  IRRITATION. 


133 


mentation,  and  opening  them  again  accelerates  it;  hence  where 
the  digestion  is  impaired,  and  the  stomach  somewhat  distended 
with  air,  it  is  better  to  restrain  than  to  encourage  eructations, 
except  the  quantity  makes  it  necessary.  When  wine  is  confined 
in  bottles,  the  fermentation  still  proceeds  slowly  even  for  years, 
till  all  the  sugar  is  converted  into  spirit;  but  in  the  process  of 
digestion,  the  saccharine  part  is  absorbed  in  the  form  of  chyle 
by  the  bibulous  mouths  of  the  numerous  lacteals,  before  it  has 
time  to  run  into  the  vinous  fermentation. 

3.  Jlpepsia.  Indigestion.  Water-qualm.  A few  mouthfuls 

of  the  aliment  are  rejected  at  a time  for  some  hours  after  meals. 
When  the  aliment  has  had  time  to  ferment,  and  become  acid,  it 
produces  cardialgia  or  heart-burn.  This  disease  is  perhaps  gene- 
rally left  after  a slight  inflammation  of  the  stomach,  called  a sur- 
feit, occasioned  by  drinking  cold  liquors,  or  eating  cold  vegeta- 
bles, when  heated  with  exercise.  This  inflammation  of  the 
stomach  is  frequently,  I believe,  at  its  commencement  removed 
by  a critical  eruption  on  the  face,  which  differs  in  its  appearance 
as  well  as  in  its  cause,  from  the  gutta  rosea  of  drunkards,  as  the 
skin  round  the  base  of  each  eruption  is  less  inflamed.  See  Class 
II.  1.4.  6.  This  disease  differs  from  cardialgia,  Class  I.  2.  4. 
5.  in  its  being  not  uniformly  attended  with  pain  of  the  cardia 
ventriculi,  and  from  its  retrograde  motions  of  a part  of  the  sto- 
mach about  the  upper  orifice  of  it.  In  the  same  manner  as  hyste- 
ria differs  from  hypochondriasis;  the  one  consisting  in  the  weak- 
ness and  indigestion  of  the  same  portions  of  the  alimentary  canal, 
and  the  other  in  the  inverted  motions  of  some  parts  of  it.  This 
apepsia  or  water-qualm  continues  many  years,  even  to  old  age. 
Mr.  G of  Litchfield  suffered  under  this  disease  from  his  in- 

fancy; and  as  he  grew  old,  found  relief  only  from  repeated  doses 
of  opium. 

M.  M.  A blister,  rhubarb,  a grain  of  opium  twice  a day. 
Soap,  iron-powder.  Tin-powder. 

4.  Vomitus.  An  inverted  order  of  the  motions  of  the  sto- 
mach and  oesophagus  with  their  absorbent  vessels,  by  which  their 
contents  are  evacuated.  In  the  act  of  vomiting  less  sensorial 
power  is  employed  than  in  the  usual  peristaltic  motion  of  the 
stomach,  as  explained  in  Sect.  XXXV.  1.  3.  Whence  after 
the  operation  of  an  emetic  the  digestion  becomes  stronger  by  an 
accumulation  of  sensorial  po\ver  during  its  decreased  action. 
This  decreased  action  of  the  stomach  may  be  either  induced  by 
want  of  stimulus,  as  in  the  sickness  which  attends  hunger;  or  it 
may  be  induced  by  temporary  want  of  irritability,  as  in  cold  fits 
of  fever:  or  from  habitual  want  of  irritability,  as  the  vomiting 


134 


DISEASES 


Class  I.  3. 1.  5. 


of  enfeebled  drunkards.  Or  lastly,  by  having  been  previously 
too  violently  stimulated  by  an  emetic  drug,  as  by  ipecacuanha. 

M.  M.  A blister.  An  emetic.  Opium.  Warmth  of  a bed, 
covering  the  face  for  a while  with  the  bed-clothes.  Crude  mer- 
cury. A poultice  with  opium  or  theriaca  externally. 

5.  Cholera.  When  not  only  the  stomach,  as  in  the  last  arti- 
cle, but  also  the  duodenum,  and  ileum,  as  low  as  the  valve  of  the 
colon,  have  their  motions  inverted;  and  great  quantities  of  bile 
are  thus  poured  into  the  stomach;  while  at  the  same  time  some 
branches  of  the  lacteals  become  retrograde,  and  disgorge  their 
contents  into  the  upper  part  of  the  alimentary  canal;  and  other 
branches  of  them  disgorge  their  contents  into  the  lower  parts  of 
it  beneath  the  valve  of  the  colon;  a vomiting  and  purging  com- 
mence together,  which  is  called  cholera,  as  it  is  supposed  to  have 
its  origin  from  increased  secretion  of  bile;  but  I suppose  more 
frequently  arises  from  putrid  food,  or  poisonous  drugs,  as  in  the 
case  narrated  in  Sect.  XXV.  13.  where  other  circumstances  of 
this  disease  are  explained.  See  Class  II.  1.2.  11. 

The  cramps  of  the  legs,  which  are  liable  to  attend  cholera, 
are  explained  in  Class  III.  1.  1.  15. 

6.  Ileus.  Consists  in  the  inverted  motions  of  the  whole  intes- 
tinal canal,  from  the  mouth  to  the  anus;  and  of  the  lacteals  and 
absorbents  which  arise  from  it.  In  this  pitiable  disease,  through 
the  valve  of  the  colon,  through  the  pylorus,  the  cardia,  and  the 
pharynx,  are  ejected,  first,  the  contents  of  the  stomach  and  in- 
testines, with  the  excrement,  and  even  clysters  themselves;  then 
the  fluid  from  the  lacteals,  which  is  now  poured  into  the  intes- 
tines by  their  retrograde  motions,  is  thrown  up  by  the  mouth; 
and,  lastly,  every  fluid,  which  is  absorbed  by  the  other  lymphatic 
branches,  from  the  cellular  membrane,  the  skin,  the  bladder,  and 
all  other  cavities  of  the  body;  and  which  is  then  poured  into 
the  stomach  or  intestines  by  the  retrograde  motions  of  the  lac- 
teals; all  which  supply  that  amazing  quantity  of  fluid,  which  is 
in  this  disease  continually  ejected  by  vomiting.  See  Sect.  XX4 
15.  for  a further  explanation  of  this  disease. 

M.  M.  Copious  venesection.  Twenty  grains  of  calomel  in 
small  pills,  or  one  grain  of  aloe  every  hour  till  stools  are  procur- 
ed. Blisters.  Warm-bath.  Crude  mercury.  Clyster  of  ice- 
water  Smear  the  skin  all  over  with  grease,  as  mentioned  in 
Sect.  XXV.  15. 

As  this  malady  is  occasioned  sometimes  by  an  introsusception 
of  a part  of  the  intestine  into  another  part  of  it,  especially  in 
children,  could  holding  them  up  by  their  heels  for  a second  or 
two  of  time  be  of  service  after  vc-nesection?  Or  the  exhibition 
of  crude  quicksilver  two  ounces  every  half  hour,  till  a pound  is 


Ciabs  I.  3.  1.  7. 


GP  IRRITATION'. 


135 


taken,  be  particularly  serviceable  in  this  circumstance?  Or 
could  half  a pound,  or  a pound,  of  crude  mercury  be  injected  as 
a clyster,  the  patient  being  elevated  by  the  knees  and  thighs  so 
as  to  have  his  head  and  shoulders  much  lower  than  his  bottom, 
or  even  for  a short  time  held  up  by  the  heels?  Could  this  also 
be  of  advantage  in  strangulated  hernia? 

Where  there  exists  an  introsusception  of  the  intestine,  or  in 
obstinate  costiveness,  perhaps  a forcing  pump,  such  as  gardeners 
employ  to  water  their  trees,  might  be  used  with  advantage,  by- 
driving  warm  water  forcibly  up  the  rectum,  as  is  mentioned  by 
Mr.  Adair;  and  was  used  by  Dettaen  in  experiments  on  dogs,  who 
found  the  valve  of  the  colon  did  not  prevent  warm  water  being 
pushed  along  the  whole  course  of  the  alimentary  canal  by  a 
forcing  syringe.  This  is  well  worthy  trial,  as  well  as  the  quick- 
silver introduced  by  the  anus  in  inflammations  of  the  intestines, 
where  no  passage  downwards  can  be  procured. 

Where  an  introsuspection  of  the  intestine  exists,  as  is  believed 
frequently  to  occur  in  those  inflammations  of  the  bowels  of 
children,  which  are  not  owing  to  some  indigestible  material,  as 
to  plum  stoues  or  cherry  stones,  it  is  probable  that  a quantity  of 
air  alone,  or  of  the  smoke  of  tobacco,  might  be  injected  so  forci- 
bly as  to  dilate,  and  in  consequence  to  pass  the  valve  of  the  colon; 
and  might  push  into  its  place  the  strangulated  duplicature  of  the 
intestine.  Air  might  be  thus  injected  from  a large  blown  bladder 
by  means  of  a clyster-pipe  covered  with  soft  leather  moistened 
with  oil  or  mucilage,  or  by  means  of  bellows,  or  the  common  ap- 
paratus for  injecting  the  smoke  of  tobacco,  or  by  a syringe  used 
for  condensing  air  in  philosophical  experiments.  I have  seen 
school-boys  blow  air  through  a grass-stem  into  the  bowels  of 
frogs,  so  as  to  prevent  their  diving,  without  injuring  them. 

Where  the  disease  is  owing  to  strangulated  hernia,  the  part 
should  be  sprinkled  with  cold  water,  or  iced  water,  or  salt  and 
water  recently  mixed,  or  moistened  with  ether.  In  cases  of 
strangulated  hernia,  could  a cupuncture,  or  puncture  with  a ca- 
pillary trocar,  be  used  with  safety  and  advantage  to  give  exit  to 
air  contained  in  the  strangulated  bowel?  Or  to  stimulate  it  in- 
to action?  It  is  not  uncommon  for  bashful  men  to  conceal 
their  being  afflicted  with  a small  hernia,  which  is  the  cause  of 
their  death;  this  circumstance  should  therefore  always  be  in- 
quired into.  Is  the  seat  or  cause  of  the  ileus  always  below  the 
valve  of  the  colon,  and  that  of  the  cholera  above  it?  See  Class 
II.  1.  2.  11. 

1 . Globus  hystericus.  Hysteric  suffocation  is  the  perception 
of  a globe  rolling  round  in  the  abdomen,  and  ascending  to  the 
stomach  and  throat,  and  there  inducing  strangulation.  It  con- 


1$6 


DISEASES 


Class  I.  3. 1. 8. 


sists  of  an  ineffectual  inversion  of  the  motions  of  the  oesophagus, 
and  other  parts  of  the  alimentary  canal;  nothing  being  rejected 
from  the  stomach. 

M.  M.  Tincture  of  castor,  tinct.  of  opium,  of  each  15  drops. 
See  Hysteria,  Class  I.  3.  1.  9. 

8.  Vomendi  conamen  inane.  An  ineffectual  effort  to  vomif. 
It  frequently  occurs,  when  the  stomach  is  empty,  and  in  some 
cases  continues  many  hours;  but  as  the  lymphatics  of  the  sto- 
mach are  not  inverted  at  the  same  time,  there  is  no  supply  of  ma- 
terials to  be  ejected;  it  is  sometimes  a symptom  of  hysteria,  but 
more  frequently  attends  irregular  epilepsies  or  reveries;  which, 
however,  may  be  distinguished  by  their  violence  of  exertion,  for 
the  exertions  of  hysteric  motions  are  feeble,  as  they  are  caused 
by  debility;  but  those  of  epilepsies,  as  they  are  used  to  relieve 
pain,  are  of  the  most  violent  kind;  insomuch  that  those  who 
have  once  seen  these  ineffectual  efforts  to  vomit  in  some  epilep- 
sies, can  never  again  mistake  them  for  symptoms  of  hysteria 
See  a case  in  Sect.  XIX.  2. 

M.  M.  Blister.  Opium.  Crude  mercury. 

9.  Borborigmus.  A gurgling  of  the  bowels  proceeds  from  a 
partial  invertion  of  the  peristaltic  motions  of  them,  by  which  the 
gas  is  brought  into  a superior  part  of  the  bowel,  and  bubbles 
through  the  descending  fluid,  like  air  rushing  into  a bottle  as  the 
water  is  poured  out  of  it.  This  is  sometimes  a distressing  symp- 
tom of  the  debility  of  the  bowels  joined  with  a partial  inversion 
of  their  motions.  I attended  a young  lady  about  sixteen,  who 
was  in  other  respects  feeble,  whose  bowels  almost  incessantly 
made  a gurgling  noise  so  loud  as  to  be  heard  at  a considerable 
distance,  and  to  attract  the  notice  of  all  who  were  near  her.  As 
this  noise  never  ceased  a minute  together  for  many  hours  in  a day, 
it  could  not  be  produced  by  the  uniform  descent  of  water,  and 
ascent  of  air  through  it,  but  there  must  have  been  alternately  a 
retrograde  movement  of  a part  of  the  bowel,  which  must  again 
have  pushed  up  the  water  above  the  air;  or  which  might  raise  a 
part  of  the  bowel,  in  which  the  fluid  was  lodged,  alternately 
above  and  below  another  portion  of  it;  which  might  readily  hap- 
pen in  some  of  the  curvatures  of  the  smaller  intestines,  the  air 
in  which  might  be  moved  backward  and  forward  like  the  air- 
bubble  in  a glass-level. 

M.  M.  Essential  oil.  Ten  corns  of  black  pepper  swallowed 
whole  after  dinner,  that  its  effect  might  be  slower  and  more  per- 
manent; a small  pipe  occasionally  introduced  into  the  rectum 
to  facilitate  the  escape  of  the  air.  Crude  mercury.  See  Class 
I.  2.  4.  9. 

10.  Hysteria.  The  three  last  articles,  together  with  the  lym- 


Ciass  I.  3.  1. 10. 


OP  IRRITATION. 


137 


phatic  diabetes,  are  the  most  common  symptoms  of  the  hysteric 
disease;  to  which  sometimes  is  added  the  lymphatic  salivation, 
and  fits  of  syncope,  or  convulsion,  with  palpitation  of  the  heart, 
(which  probably  consists  of  retrograde  motions  of  it,)  and  a great 
fear  of  dying.  Which  last  circumstance  distinguishes  these  con- 
vulsions from  the  epileptic  ones  with  greater  certainty  than  any 
other  single  symptom.  The  pale  copious  urine,  cold  skin,  palpi- 
tation and  trembling,  are  the  symptoms  excited  by  great  fear. 
Hence  in  hysteric  diseases,  when  these  symptoms  occur,  the  fear, 
which  has  been  usually  associated  with  them,  recurs  at  the  same 
time,  as  in  hypochondriasis,  Class  I.  2.  4.  10.  See  Sect.  XVI. 
8.  1. 

The  convulsions  which  sometimes  attend  the  hysteric  disease, 
are  exertions  to  relieve  pain,  either  of  some  torpid,  or  of  some 
retrograde  organ;  and  in  this  respect  they  resemble  epileptic 
convulsions,  except  that  they  are  seldom  so  violent  as  entirely  to 
produce  insensibility  to  external  stimuli;  for  these  weaker  pains 
cease  before  the  total  exhaustion  of  sensorial  power  is  produced, 
and  the  patient  sinks  into  imperfect  syncope;  whereas  the  true 
epilepsy  generally  terminates  in  temporary  apoplexy,  with  per- 
fect insensibility  to  external  objects.  These  convulsions  are  less 
to  be  dreaded  than  the  epileptic  ones,  as  they  do  not  originate 
from  so  permanent  a cause. 

The  great  discharge  of  pale  urine  in  this  disease  is  owing  to 
the  inverted  motions  of  the  lymphatics,  which  arise  about  the 
neck  of  the  bladder,  as  described  in  Sect.  XXIX.  4.  5.  And 
the  lymphatic  salivation  arises  from  the  inverted  motions  of  the 
salivary  lymphatics. 

Hysteria  is  distinguished  from  hypochondriasis,  as  in  the  latter 
there  are  no  retrograde  motions  of  the  alimentary  canal,  but  sim- 
ply a debility  or  in  irritability  of  it,  with  distention  and  flatulency. 
It  is  distinguished  from  apepsia  and  cardialgia  by  there  being 
nothing  ejected  from  the  stomach  by  the  retrograde  motions  of 
it,  or  of  the  oesophagus. 

M.  M.  Opium.  Camphor.  Asafoetida.  Castor,  with  sina- 
pisms externally;  to  which  must  be  added  a clyster  of  cold  wa- 
ter, or  iced  water;  which,  according  to  Mons.  Pomme,  relieves 
these  hysteric  symptoms  instantaneously  like  a charm;  which  it 
may  effect  by  checking  the  inverted  motions  of  the  intestinal  ca- 
nal by  the  torpor  occasioned  by  cold;  or  one  end  of  the  intesti- 
nal canal  may  become  strengthened,  and  regain  its  peristaltic 
motion  by  reverse  sympathy,  when  the  other  end  is  rendered 
torpid  by  ice-water.  (Pommes  des  Affections  Vaporeuses,  p.  25.) 
These  remove  the  present  symptoms;  and  bark,  steel,  exercise, 
coldish  bath,  prevent  their  returns.  See  Art.  VI.  2.  1. 

VOL.  II.  t 


138 


DISEASES 


Class  I.  3. 1.  li. 


1 1 . Hydrophobia.  Dread  of  water  occasioned  by  the  bite  of  a 
mad-dog,  is  a violent  inversion  of  the  motions  of  the  oesopha- 
gus on  the  contact  or  even  approach  of  water  or  other  fluids. 
The  pharynx  seems  to  have  acquired  the  sensibility  of  the  larynx 
in  this  disease,  and  is  as  impatient  to  reject  any  fluid  which  gets 
into  it.  Is  not  the  cardia  ventriculi  the  seat  of  this  disease?  As 
in  cardialgia  the  pain  is  often  felt  in  the  pharynx,  when  the  acid 
material  stimulates  the  other  end  of  the  canal,  which  terminates 
in  the  stomach.  As  this  fatal  disease  resembles  tetanus,  or  lock- 
ed jaw,  in  its  tendency  to  convulsion  from  a distant  wound,  and 
affects  some  other  parts  by  association,  it  is  treated  of  in  Class 
III.  1.  1.  15.  and  IV.  2.  1.  7. 

M.  M.  I should  recommend  the  trial  of  one  grain  and  a half 
of  corrosive  sublimate  of  mercury,  hydrargyrus  muriatus,  dis- 
solved in  half  an  ounce  of  rectified  spirit  of  wine,  to  be  given 
undulated,  if  possible,  as  described  in  Class  II.  1.  5.  1.  and  to  be 
repeated  according  to  its  operation. 


Class  I.  3.  2.  1, 


OT  IRRITATION. 


139 


ORDO  III. 

Retrograde  Irritative  JMotions, 

GENUS  II. 

Of  the  Absorbing  System, 

SPECIES. 

] . Catarrhus  Lymphaticus.  Lymphatic  catarrh.  A periodi- 
cal defluxion  of  a thin  fluid  from  the  nostrils,  for  a few  hours, 
occasioned  by  the  retrograde  motions  of  their  lymphatics;  which 
may  probably  be  supplied  with  fluid  by  the  increased  absorption 
of  some  other  lymphatic  branches  in  their  vicinity.  It  is  dis- 
tinguished from  that  mucous  discharge,  which  happens  in  frosty 
weather  from  decreased  absorption,  because  it  is  less  salt  to  the 
taste;  and  from  an  increased  secretion  of  mucus,  because  it  is 
neither  so  viscid,  nor  is  attended  with  heat  of  the  part.  This 
complaint  is  liable  to  recur  at  diurnal  periods,  like  an  intermit- 
tent fever,  for  weeks  and  months  together,  with  great  sneezing 
and  very  copious  discharge  for  an  hour  or  two. 

I have  seen  two  of  these  cases,  both  of  which  occurred  in  deli- 
cate women,  and  seemed  an  appendage  to  other  hysteric  symp- 
toms; whence  I concluded,  that  the  discharge  w'as  occasioned  by 
the  inverted  motions  of  the  lymphatics  of  the  nostrils,  like  the 
pale  urine  in  hysteric  cases;  and  that  they  might  receive  this 
fluid  from  some  other  branches  of  lymphatic  vessels  opening  into 
the  frontal  or  maxillary  cavities  in  their  vicinity. 

Could  such  a discharge  be  produced  by  strong  errhines,  and 
excite  an  absorption  of  the  congestion  of  lymph  in  the  dropsy  of 
the  brain? 

2.  Salivatio  lymphatica.  Lymphatic  salivation.  A copious 
expuition  of  a pellucid  insipid  fluid,  occasioned  by  the  retrograde 
motions  of  the  lymphatics  of  the  mouth.  It  is  sometimes  peri* 
odical}  and  often  attends  the  hysteric  disease,  and  nervous  fevers; 
but  is  not  accompanied  with  a saline  taste,  or  with  heat  of  the 
mouth,  or  nausea. 

3.  Nausea  humida.  Moist  nausea  consists  in  a discharge  of 
fluid,  owing  to  the  retrograde  motions  of  the  lymphatics  about  the 
fauces,  without  increase  of  heat,  or  saline  taste,  together  with 
some  retrograde  motions  of  the  fauces  or  pharynx;  along  with 
this  nausea,  a sickness  generally  precedes  the  act  of  vomiting; 
which  may  consist  of  a similar  discharge  of  mucus  or  chyle  into 


140 


DISEASES 


Class  I.  3.  2.  4, 

the  stomach  by  the  retrograde  motions  of  the  lymphatics  orlacteal- 
which  open  into  it.  See  Class  I.  2.  4.  ti.  and  I.  2.  4.  4. 

M.  M.  Subacid  liquids.  Wine.  Opium.  A blister. 

4.  Diarrhoea  lymphatica.  Lymphatic  diarrhoea.  A quantity 
of  mucus  and  lymph  are  poured  into  the  intestines  by  the  in- 
verted motions  of  the  intestinal  lymphatics.  The  feces  are  less 
fetid  and  more  liquid;  and  it  sometimes  portends  the  commence- 
ment of  a diabetes,  or  dropsy,  or  their  temporary  relief.  This 
lymphatic  diarrhoea  sometimes  becomes  chronical,  in  which  the 
atmospheric  moisture,  absorbed  by  the  cutaneous  and  pulmonary 
lymphatics,  is  poured  into  the  intestines  by  the  retrograde  mo- 
tions of  the  lacteals.  See  Section  XXIX.  4.  6.  where  some 
cases  of  this  kind  are  related. 

5.  Diarrhoea  chylifera,  codiaca.  Chyliferous  diarrhoea.  The 
chyle  drunk  up  by  the  lacteals  of  the  upper  intestines  is  poured 
into  the  lower  ones  by  the  retrograde  motions  of  their  lacteals, 
and  appears  in  the  dejections.  This  circumstance  occurs  at  the 
beginning  of  diarrhoea  crapulosa.  where  the  patient  has  taken 
and  digested  more  aliment  than  the  system  can  conveniently  re- 
ceive, and  thus  eliminates  a part  of  it;  as  appears  when  there  is 
curdled  chyle  in  some  of  the  dejections.  See  Sect.  XXIX.  4.  7. 
It  differs  from  the  lymphatic  diarrhoea,  as  the  chyliferous  diabe- 
tes differs  from  the  aqueous  and  mucaginous  diabetes. 

6.  Diabetes.  By  the  retrograde  motions  of  the  urinary  lym- 
phatics, an  immense  quantity  of  fluid  is  poured  into  the  bladder. 
It  is  either  termed  chyliferous,  or  aqueous,  or  mucaginous,  from 
the  nature  of  the  fluid  brought  into  the  bladder;  and  is  either  a 
temporary  disease,  as  in  hysteric  women,  in  the  beginning  of  in- 
toxication, in  worm  cases,  or  in  those  exposed  to  cold  damp  air. 
or  to  great  fear  or  anxiety,  or  in  the  commencement  of  some  drop- 
sies; or  it  becomes  chronical. 

When  the  urinary  lymphatics  invert  their  motions,  and  pour 
their  refluent  contents  into  the  bladder,  some  other  branch  of  the 
absorbent  system  acts  with  greater  energy  to  supply  this  fluid. 
If  it  is  the  intestinal  branch,  the  chyliferous  diabetes  is  produced: 
if  it  is  the  cutaneous  or  pulmonary  branch,  the  aqueous  diabetes 
is  produced:  and  if  the  cellular  or  cystic  branches,  the  mucagi- 
nous diabetes.  In  the  two  last  the  urine  is  pellucid,  and  contains 
no  sugar. 

In  dropsies  the  fluid  is  sometimes  absorbed,  and  poured  into 
the  bladder  by  the  retrograde  motions  of  the  urinary  lymphatics, 
as  during  the  exhibition  of  digitalis.  In  the  beginning  of  the 
dropsies  of  infirm  gouty  patients,  I have  frequently  observed, 
that  they  make  a large  quantity  of  water  for  one  night,  which 
relieves  them  for  several  days.  In  these  cases  the  patient  previ- 


Gi ass  I.  3.  2.  4. 


OF  IRRITATION. 


141 


ously  feels  a fulness  about  the  praecordia,  with  difficult  respira- 
tion, and  symptoms  similar  to  those  of  hysteria.  Perhaps  a pre- 
vious defect  of  absorption  takes  place  in  some  part  of  the  body  in 
those  hysteric  cases,  which  are  relieved  by  a copious  discharge  of 
pale  urine.  See  Diabetes  explained  at  large,  Section  XXIX.  4. 

A discharge  of  blood  sometimes  attends  the  diabetes,  which 
was  occasionally  a symptom  of  that  disease  in  Mr.  Brindley,  the 
great  navigable  canal  maker  in  this  country.  Which  may  be 
accounted  for  by  the  communication  of  a lymphatic  branch  with 
the  gastric  branch  of  the  vena  portarum,  as  discovered  by  J.  F. 
Meckel.  See  Section  XXVII.  2. 

M.  M.  Alum.  Earth  of  alum.  Cantharides.  Calomel.  Bark, 
Steel.  Resin.  Opium.  See  Sect.  XXIX.  4. 

Since  the  publication  of  the  first  edition  of  this  work,  I have 
seen  two  patients  affected  with  diabetes,  who  were  both  of  them 
between  sixty  and  seventy  years  old,  and  had  formerly  lived  ra- 
ther freely,  though  very  temperately  latterly  for  many  years.  The 
water  they  made  had  not  been  accurately  measured  or  evaporat- 
ed; but  one  of  them  observed  that  his  terrier  bitch  lapped  his 
urine  in  large  quantities,  and  preferred  it  much  to  common  wa- 
ter; whence  he  concluded,  it  must  contain  some  nutritious  matter. 

They  both  complained  of  thirst,  and  had  drunk  two  or  three 
times  as  much  as  usual,  during  the  time  they  had  been  affected 
with  the  diabetes;  which  was  about  four  months  in  one,  and 
about  three  in  the  other.  As  I esteemed  these  cases  to  be  ow- 
ing to  the  patient’s  swallowing  more  fluid  than  could  be  so  has- 
tily taken  into  the  circulation,  and  that  therefore  a part  of  it  wTas 
conveyed  to  the  bladder  by  the  retrograde  action  of  the  lympha- 
tics, as  in  the  beginning  of  intoxication;  I prevailed  on  them  to 
drink  no  more  than  their  usual  quantity,  or  less;  and  both  these 
mild  cases  of  diabetes  ceased  immediately  by  this  simple  treat- 
ment of  them. 

A similar  event  seems  to  have  existed  in  the  two  cases  of  dia- 
betes first  published  by  Dr.  Rollo;  on  those  days  the  patients 
drank  but  little,  the  quantity  of  urine  was  not  more  than  natural- 
Both  from  these  cases,  and  from  others  related  by  Dr.  Rollo,  it 
appears,  that  when  the  patient  lived  on  animal  food,  less  saccha- 
rine matter  was  detected  in  the  urine,  and  also  that  the  quantity 
of  the  urine  abated;  the  former  of  these  circumstances  is  readily 
accounted  for,  as  vegetable  materials  are  probably  more  copi- 
ously convertible  into  sugar,  either  chemically  or  by  the  power 
of  digestion,  than  animal  materials;  and  the  latter  seems  proba- 
bly owing  to  the  patients  drinking  less  in  quantity,  when  they 
were  restrained  from  beer  and  milk,  and  were  allowed  only 
broth  in  their  stead. 


142 


DISEASES 


6ia*s  I.  3.  2.  f. 


In  the  ease  from  Liverpool,  published  by  Dr.  Rollo,  the  patient 
did  not  weigh  heavier  after  sitting  ten  minutes  in  a bath  of  110 
degrees  of  heat;  which  shews  that  no  part  of  the  diabetic  urine 
was  owing  to  increased  cutaneous  absorption,  and  that  this  dis- 
ease was  not  the  aqueous  but  the  chyliferous  diabetes;  and  I sup- 
pose the  patient’s  weighing  heavier  or  not  after  using  a warm 
bath  may  depend  on  the  quantity  of  fluid  previously  taken  by  the 
mouth;  as  the  skin  may  thence  be  either  in  an  absorbent  or  ex- 
halant  state,  and  owing  to  a greater  or  less  degree  of  heat,  which 
may  render  the  quantity  of  perspiration  in  the  bath  greater  than 
the  quantity  absorbed.  See  Sect.  XXIX.  4.  5. 

7.  Sudor  lymphaticus.  Profuse  sweats  from  the  inverted  mo- 
tions of  the  cutaneous  lymphatics,  as  in  some  fainting  fits,  and 
at  the  approach  of  death;  and  as  perhaps  in  the  sudor  anglica- 
nus.  See  Sect.  XXIX.  5.  These  sweats  are  glutinous  to  the 
touch,  and  without  increased  heat  of  the  skin;  if  the  part  is  not 
covered,  the  skin  becomes  cold  from  the  evaporation  of  the  fluid. 
These  sweats  without  heat  sometimes  occur  in  the  act  of  vomit- 
ing, as  in  Sect.  XXV.  9.  and  are  probably  the  cause  of  the  cold 
sweaty  hands  of  some  people.  As  mentioned  in  Sect.  XXIX. 
4.  9.  in  the  case  of  R.  Davis,  which  he  cured  by  frequent  ap- 
plication of  lime.  Though  it  is  possible,  that  cold  sweaty  hands 
may  also  arise  from  the  want  of  due  absorption  of  the  perspirable 
matter  effused  on  them,  and  that  the  coldness  may  be  owing  to 
the  greater  evaporation  in  consequence. 

The  acid  sweats  described  by  Dr.  Dobson,  which  he  observed 
in  a diabetic  patient,  and  ascribes  to  the  chyle  effused  on  the 
skin,  must  be  ascribed  to  the  retrograde  action  of  the  cutaneous 
lymphatics.  See  Sect.  XXIX.  6. 

8.  Suclor  Asthmaticus.  The  cold  sweats  in  this  disease  only 
cover  the  head,  arms,  and  breast,  and  are  frequently  exceeding- 
ly profuse.  These  sweats  are  owing  to  the  inverted  motions  of 
the  cutaneous  lymphatics  of  the  upper  part  of  the  body,  and  at 
the  same  time  the  increased  absorptionof  the  pulmonary  absorb- 
ents: hence  these  sweats  when  profuse  relieve  the  present  fit  of 
asthma.  There  is  no  other  way  to  account  for  sweats  appear- 
ing on  the  upper  parts  of  the  body  only,  but  by  the  fluid  having" 
been  absorbed  by  the  lymphatic  branch  of  the  lungs,  and  effused 
on  the  skin  by  the  retrograde  movements  of  the  cutaneous  lym- 
phatics; which  join  those  of  the  lungs  before  they  enter  into  the 
venous  circulation.  For  if  they  were  occasioned,  as  general- 
ly supposed,  by  the  difficulty  of  the  circulation  of  the  blood 
through  the  lungs,  the  whole  skin  must  be  equally  affected,  both 
of  the  upper  and  lower  parts  of  the  body;  for  whatever  could 
obstruct  the  circulation  in  the  upper  part  of  the  venous  system. 


CiassI.  3.  2.  9.  • 


OF  IRRITATION. 


143 


must  equally  obstruct  it  in  the  lower  part  of  it.  See  Sect.  XXIX. 
6.  In  the  convulsive  asthma  these  sweats  do  not  occur;  hence 
they  may  be  distinguished;  and  might  be  called  the  hydropic 
asthma,  and  the  epileptic  asthma. 

9.  Translatio  puris.  Translation  of  matter  from  one  part  of 
the  system  to  another  can  only  be  explained  from  its  being  ab- 
sorbed by  one  branch  of  the  lymphatic  system,  and  deposited  in 
a distant  part  by  the  retrograde  motions  of  another  branch;  as 
mentioned  in  Sect.  XXIX.  7.  1 . It  is  curious,  that  these  trans- 
lations of  matter  are  attended  generally,  I believe,  with  cold  fits; 
for  less  heat  is  produced  during  the  retrograde  action  of  this 
part  of  the  system,  as  no  secretion  in  the  lymphatic  glands  of  the 
affected  branches  can  exist  at  the  same  time.  Do  any  ineffectual 
retrograde  motions  occasion  the  cold  fits  of  agues?  The  time  when 
the  gout  of  the  liver  ceases,  and  the  gout  in  the  foot  commences, 
is  attended  with  a cold  fit,  as  I have  observed  in  two  instances, 
which  is  difficult  to  explain,  without  supposing  the  new  vessels,  or 
the  matter  produced  on  the  inflamed  liver,  to  be  absorbed,  and 
either  eliminated  by  some  retrograde  motion,  or  carried  to  the 
newly  inflamed  part?  See  Class  IV.  1.2.  15. 

10.  Translatio  lactis.  Translation  of  milk  to  the  bowels  in 
puerperal  fevers  can  only  be  explained  by  the  milk  being  ab- 
sorbed by  the  pectoral  branch  of  lymphatics,  and  carried  to  the 
bowels  by  the  retrograde  motions  of  the  intestinal  lymphatics  or 
lacteals.  See  many  instances  of  this  in  Sect.  XXIX.  7.  4. 

11.  Translatio  urince.  Translation  of  urine.  There  is  a cu- 
rious case  related  in  the  Transactions  of  the  College  of  Physicians 
at  Philadelphia,  Vol.  I.  p.  96.  of  a girl,  who,  labouring  under  an 
ischuria,  vomited  her  urine  for  many  months;  which  could  not 
be  distinguished  from  that  which  was  at  other  times  drawn  off 
by  the  catheter.  After  having  taken  much  opium  she  seems  at 
length  to  have  formed  gravel,  some  of  which  was  frequently 
brought  up  by  vomiting.  Dr.  Senter  ascribes  this  to  the  retro- 
grade motions  of  the  lymphatics  of  the  stomach,  and  the  in- 
creased ones  of  those  of  the  bladder,  and  refers  to  those  of  Sect. 
XXIX.  of  this  work;  which  section  was  first  published  in  1780; 
and  to  Maquer’s  Dictionary  of  Chemistry,  Art.  Urine. 

The  patient  above  described  sometimes  had  a discharge  of 
urine  by  the  navel,  and  at  other  times  by  the  rectum,  and  some- 
times by  urinous  sweats 


144 


DISEASES 


Glass  I.  o.  ^ . i . 


ORDO  III. 

Retrograde  Irritative  Motions. 

GENUS  III. 

Of  the  Sanguiferous  System. 

SPECIES. 

1.  Capillarium  motus  retrogressus.  In  microscopic  experi- 
ments it  is  usual  to  see  globules  of  blood  regurgitate  from  the 
capillary  vessels  again  and  again,  before  they  pass  through  them; 
and  not  only  the  mouths  of  the  veins,  which  arise  from  these  ca- 
pillaries, are  frequently  seen  by  microscopes  to  regurgitate  some 
particles  of  blood  during  the  struggles  of  the  animal;  but  a retro- 
grade motion  of  the  blood  in  the  veins  of  these  animals,  from 
the  very  heart  to  the  extremities  of  the  limbs,  is  observable  by 
intervals  during  the  distresses  of  the  dying  creature.  Haller, 
Elem.  Phys.  T.  l.p.  216.  See  Section  XXIX.  3.  8. 

2.  Palpitatio  cordis.  May  not  the  ineffectual  and  weak  une- 
qual motions  of  the  heart  in  hysteric  cases  be  ascribed  to  the  re- 
trograde motions  of  it,  which  continue  for  a short  time,  or  ter- 
minate in  syncope?  See  Class  IV.  3.  1.6. 

3.  Jlnhelatio  spasmodica.  In  some  asthmas  may  not  the  difficulty 
of  respiration  arise  from  the  inverted  action  of  the  finer  branches 
of  the  bronchia,  or  of  the  pulmonary  artery  or  vein,  like  those  of 
the  capillaries  above  described  in  No.  1.  of  this  genus  ? 


Class  II.  1,  X 


DISEASES,  &c. 


145 


The  Orders  and  Genera  of  the  Second  Class  of 
Diseases. 

CLASS  II. 

DISEASES  OF  SENSATION. 

ORDO  I. 

Increased  Irritation. 

GENERA. 

1.  With  increased  action  of  the  muscles. 

2.  With  the  production  of  new  vessels  by  internal  membranes  or 

glands  with  fever. 

3.  With  the  production  of  new  vessels  by  external  membranes  or 

glands  with  fever. 

4.  With  the  production  of  new  vessels  by  internal  membranes  or 

glands  without  fever. 

5.  With  the  production  of  new  vessels  by  external  membranes  or 

glands  without  fever. 

6.  With  fever  consequent  to  the  production  of  new  vessels  or 

fluids. 

7.  With  increased  actions  cf  the  organs  of  sense. 

ORDO  II. 

Decreased  Sensation. 

GENERA. 

1.  With  decreased  actions  of  the  general  system 

2.  With  decreased  actions  of  particular  organs. 

ORDO  III. 

Retrograde  Sensitive  Motions. 

GENERA. 

1.  Of  the  arterial  system. 

2.  Of  the  absorbent  system 

3.  Of  the  excretory  ducts- 


VOL.  It. 


V 


146 


.DISEASES 


Class  II.  1.  I- 


The  Orders,  Genera,  and  Species,  of  the  Second  Class 
of  Diseases. 

CLASS  II. 


DISEASES  OF  SENSATION. 

ORDO  I. 


Increased  Sensation. 
GENUS  I. 


With  increased  Action  of  the  Muscles. 


1.  Deglutitio 

2.  Respiratio 

3.  Sternutatio 

4.  Anhelitus 
6.  Tussis  ebriorum 

6.  Singultus 

7.  Crapula  ventriculi. 

8.  Asthma  humorale 

9.  Nictitatio  sensiliva 

10.  Oscitalio  et  pandicidatio 

1 1 . Tenesmus 

12.  Stranguria 

13.  Parturilio 


SPECIES. 

Deglutition 
Respiration 
Sneezing 
Panting 

Cough  of  inebriates 
Hiccough 
Indigestion 
Humoral  asthma 
Winking  from  pain 
Yawning  and  stretching 
Tenesmus 
Strangury 
Parturition 


GENUS  II. 

With  the  Production  of  new  Vessels  by  interned  Membranes  or 
Glands , with  Fever. 


SPECIES. 


1 . Febns  sensitiva  irritata 

2.  Ophthalmia  internia 

3.  Phrenitis 

4.  Peripneumonia 
trachealis 

5.  Pleuritis 

6.  Diaphragmitis 

7.  Carditis 

8.  Peritonitis 


Sensitive  irritated  fever 
Inflammation  of  the  eye 

of  the  brain 

of  the  lungs 

The  croup 

Inflammation  of  the  pleura 

. of  the  diaphragm 

of  the  heart 

— of  the  peritone- 

um 

— of  the  mesentery 


D.  Mesenterilis 


Class  II.  1.  3. 


OF  SENSATION. 


147 


10.  Gastritis 

11.  Enteritis 

12.  Hepatitis 

13.  Splenitis 

14.  Nephritis 

1 5.  Cystitis 

16.  Hysteritis 

17.  Lumbago  sensitiva 

18.  Ischias 

19.  Paronychia  interna 


Inflammation  of  the  stomach 

of  the  bowels 

of  the  liver 

of  the  spleen 

of  the  kidney 

of  the  bladder 

of  the  womb 

of  the  loins 

of  the  pelvis 

- beneath  the  nails 


GENUS  III. 

With  the  Production  of  new  Vessels  by  external  Membranes  or 
Glands , with  Fever. 


SPECIES. 


1 . Febris  sensitiva  inirritata 

2.  Erisipelas  irritatum 

inirritatum 

■ sensitivum 

3.  Tonsillitis  interna 

superficialis 

inirritata 

4.  Parotitis  suppurans 

mutabilis 

felina 

5.  Catarrhus  sensitivus 

6.  contagiosus 

equinus  et  cani- 

nus 

7.  Peripneumonia  superficicdis 

8.  Pertussis 

9.  Variola  discreta 

• conjluens 

inoculata 

10.  Rubeola  irritata 
inirritata 

11.  Scarlatina  mitis 
maligna 

12.  Miliaria  sudatoria 

irritata 

inirritata 

13.  Pestis 
vaccina 

14.  Pemphigus 


Sensitive  inirritated  fever 
Erysipelas,  irritated 

inirritated 

sensitive 

Angina,  internal 

superficial 

inirritated 

Mumps,  suppurative 

mutable 

of  cats 

Catarrh,  inflammatory 

contagious 

among  horses  and  dogs 

Superficial  peripneumony 
Chin-cough 
Small-pox,  distinct 

confluent 

inoculated 

Measles,  irritated 

inirritated 

Scarlet  fever,  mild 

malignant 

Miliary  fever,  sudatory 

irritated 

inirritated 

Plague 

of  horned  cattle 

Bladdery  fever 


148 


DISEASES 


Class  II.  1,  4. 


15.  Varicella 

16.  Urticaria 

17.  Aphtha  sensiliva 

irritata 

— inirritata 

18.  Dysenteria 

19.  Gastritis  superficialis 

20.  Enteritis  superficialis 


Chicken-pox 
Nettle-rash 
Thrush,  sensitive 

irritated 

inirritated 

Bloody  flux 

Superficial  inflam,  of  the  sto- 
mach 

of  the  bowels 


GENUS  IV. 

With  the  Production  of  new  Vessels  by  internal  Membranes  o . 
Glands , without  Fever. 


SPECIES. 


1 . Ophthalmia  superficialis 

• lymphatica 

equina 

2.  Pterigion 

3.  Tarsitis  palpebrarum 

4.  Hordeolum 

5.  Paronychia  superficialis 

6.  Guttu  rosea  hepatica 

. slomatica 

hereditaria 

7.  Odontitis 

8.  Otitis 

9.  Fistula  lacrymalis 

10,  Fistula  in  ano 

11,  Hepatitis  chronica 

12,  Scrofula  suppurans 

13,  Scorbutus  suppurans 

14,  Scirrhus  suppurans 

15,  Carcinoma 

16,  Arthrocele 

17,  Arthropuosis 

18,  Caries  ossium 


Ophthalmy,  superficial 

lymphatic 

of  horses 

Eye-wing 
Red  eyelids 
Stye 
Whitlow 

Pimpled  face,  hepatic 

stomatic 

hereditary 

Inflamed  tooth 

ear 

Fistula  lacrymalis 
Fistula  in  ano 
Chronical  hepatitis 
Suppurating  scrofula 
Suppurating  scurvy 
Suppurating  scirrhus 
Cancer 

Swelling  of  the  joints 
Suppuration  of  the  joints 
Caries  of  the  bones 


GENUS  V. 


With  the  Production  of  new  Vessels  by  external  Mev{branes  or 
Glands , without  Fever. 


1 . Gonorrhoea  venerea 


SPECIES. 

Clap 

Venereal  disease 


Class.  II.  1.  6. 


OP  SENSATION. 


149 


3.  Lepra 

Leprosy 

4.  Elephantiasis 

Elephantiasis 

5.  Frambcesia 

Frambcesia 

6.  Psora 

Itch 

7.  Psora  ebriorum 

Itch  of  drunkards 

8.  Herpes 

Herpes 

9.  Zona  ignea 

Shingles 

10.  Annulus  repens 

Ring- worm 

1 1 . Tinea  capitis 

Scald-head 

12.  Crusta  lactea 

Milk-crust 

13.  Trichoma 

Plica  polonica 

GENUS  VI. 

With  Fever  consequent  to  the  Production  of  new  Vessels  or  Fluids, 

SPECIES. 

1.  Febris  sensitiva 

Sensitive  Fever 

2. a pure  clauso 

Fever  from  concealed  matter 

3. a vomica 

from  vomica 

4. ab  empyemate 

from  empyema 

5. mesenterica 

mesenteric 

6. a pure  aerato 

from  aerated  matter 

7. a phthisi 

from  consumption 

8. scrofulosa 

scrofulous 

9. ischiadica 

from  ischias 

10.  — — artliropuodica 

from  joint-evil 

1 1 . a pure  contagioso 

from  contagious  matter 

12. variolosa  secundana 

secondary  of  small-pox 

13. carcinomatosa 

cancerous 

1 4. venerea 

venereal 

1 5. a sanie  contagiosa 

from  contagious  sanies 

16. puerpera 

puerperal 

17. a sphacelo 

from  sphacelus 

GENUS  VII. 

W ith  Increased  Action  of  the  Organs  of  Sense. 

SPECIES. 


1 . Delirium  febrile 

2.  maniacale 

3.  ebrietatis 

4.  Somnium 

5.  Hallucinatio  visits 

6.  audilds 

7.  Rvbor  a color e 


Delirium  of  fevers 

maniacal 

of  drunkenness 

Dreams 

Deception  of  sight 

of  hearing 

Blush  from  heat 


150 


DISEASES 


Class  II.  2.  1 


8.  Rubor  jucunditalis  Blush  from  joy 

9.  Pricipismus  amatorius  Amorous  priapism 

10.  Distentio  mamularum  Distention  of  the  nipples 

ORDO  IT. 

Decreased  Sensation. 

GENUS  I. 

With  decreased  Action  of  the  General  System. 
SPECIES. 

1.  Slultitia  insensibilis  Folly  from  insensibility 

2.  Tcedium  vitae  Irksomeness  of  life 

3.  Paresis  sensitiva  Sensitive  debility 

GENUS  II. 

With  decreased  Actions  of  particular  Organs.. 
SPECIES. 

Want  of  appetite 
Want  of  thirst 
Impotence 
Barrenness 

Insensibility  of  the  limbs 
Insensibility  of  the  bladder 
Accumulation  of  feces 

ORDO  III. 

Retrograde  Sensitive  Motions. 

GENUS  I. 

Of  Excretory  Duels. 

SPECIES. 

Moius  retrogressus  Retrograde  motion 

1 .  ureterurn  of  the  ureters 

2.  urethrae  of  the  urethra 

3.  ducids  choledoci of  the  bile-duct 


1.  Anorexia 

2.  Adipsia 

3.  Impotenlia 

4.  Sterilitas 

5.  Inscnsibilitas  artuum 

6.  Dysuria  insensitiva 

7.  Accumulalio  alvina 


Glass  II.  1.  3. 


OF  SENSATION. 


151 


CLASS  II. 

DISEASES  OF  SENSATION. 

ORDO  I. 

Increased  Sensation. 

GENUS  I. 

With  increased  diction  of  the  Muscles. 

The  actions  belonging  to  this  genus  are  those  which  are  im- 
mediately excited  by  the  sensations  of  pain  or  pleasure,  but 
which  are  neither  followed  by  inflammation  nor  by  convulsion. 
The  former  of  which  belong  to  the  subsequent  genera  of  this 
order,  and  the  latter  to  the  class  of  voluntary  motions. 

The  criterion  between  the  actions,  which  are  the  immediate 
consequence  of  painful  sensation,  and  convulsive  actions  pro- 
perly so  called,  consists  in  the  former  having  a tendency  to  dis- 
lodge the  stimulating  cause,  which  induces  the  painful  sensation; 
and  the  latter  being  exerted  for  the  purpose  of  expending  the 
sensorial  power,  and  thus  dulling  or  destroying  the  general  sen- 
sation of  the  system.  See  Class  III.  1. 

There  is  a degree  of  heat  produced  in  the  affected  part  by 
these  sensitive  actions  without  inflammation,  but  in  much  less 
quantity  than  when  attended  by  inflammation;  as  in  the  latter 
there  is  production  of  new  vessels.  See  Sect.  XXXIII.  2.  3. 

Some  of  the  species  of  this  genus  cannot  properly  be  termed 
diseases  in  their  natural  state,  but  become  so  by  their  defect  or 
excess,  and  are  here  inserted  to  facilitate  the  explanation  of  the 
others. 

SPECIES. 

1.  Deglutitio.  Swallowing  our  food  is  immediately  caused 
by  the  pleaurable  sensation  occasioned  by  its  stimulus  on  the 
palate  or  fauces,  and  is  acquired  long  before  the  nativity  of  the 
animal.  Afterwards  the  pain  of  hunger  previously  produces 
the  various  voluntary  exertions  to  procure  the  proper  material, 
but  the  actions  of  masticating  and  of  swallowing  it  are  effected 
by  the  sensorial  power  of  sensation;  which  appears  by  their  not 
being  always  controllable  by  the  will,  as  when  children  in  vain 
attempt  to  swallow  nauseous  drugs.  See  Class  IV.  1.  3.  1. 


DISEASES 


Class  II.  1.  2. 


152 

The  masticated  food  stimulates  the  palate,  which  is  an  organ  of 
sense,  into  so  much  action,  as  to  produce  agreeable  sensation; 
and  the  muscles  subservient  to  deglutition  are  brought  into  ac- 
tion by  the  sensation  thus  produced.  The  pleasurable  sensa- 
tion is  the  proximate  cause;  the  action  of  the  fibres  of  the  ex- 
tremities of  the  nerves  of  taste  is  the  remote  cause;  the  senso- 
rial power  of  irritation  exciting  these  fibres  of  the  nerves  of  taste 
into  increased  action  is  the  pre-remote  cause;  the  action  of  the 
muscles  of  deglutition  is  the  proximate  elfect;  the  pushing  the 
food  into  the  stomach  is  the  remote  effect;  and  the  nutrition  of 
the  body  is  the  post-remote  effect. 

Though  the  muscles  subservient  to  deglutition  have  their  ac- 
tions previously  associated,  so  as  to  be  excited  into  synchronous 
tribes  or  successive  trains,  either  by  volition,  as  when  we  swal- 
low a disagreeable  drug;  or  by  sensation,  as  when  we  swallow' 
agreeable  food;  or  by  irritations,  as  when  we  inattentively  swal- 
low our  saliva;  yet  do  all  those  three  kinds  of  deglutition  belong 
to  the  respective  classes  of  volition,  sensation,  and  irritation; 
because  the  first  links  of  these  tribes  or  trains  of  muscular  action 
are  excited  by  those  sensorial  powers,  and  the  associated  links, 
which  accompany  or  succeed  them,  are  excited  by  the  combined 
powers  either  of  volition,  or  of  sensation,  or  of  irritation,  along 
with  that  of  association. 

2.  Respiratio.  Respiration  is  immediately  caused  bv  the  sen- 
sorial power  of  sensation  in  consequence  of  the  baneful  want  of 
vital  air;  and  not  from  the  accumulation  of  blood  in  the  lungs, 
as  that  might  be  carried  on  by  inhaling  azote  alone,  without  the 
oxygenous  part  of  the  atmosphere.  The  action  of  respiration  is 
thus  similar  to’  that  of  swallowing  our  food  to  appease  the  pain 
of  hunger;  but  the  lungs  being  surrounded  with  air,  their  proper 
pabulum,  no  intermediate  voluntary  exertions  are  required,  as  in 
hunger,  to  obtain  and  prepare  the  wanted  material. 

Respiration  is  similar  to  slow  combustion;  the  oxygenous  part 
of  the  atmosphere  is  received  through  the  moist  membranes, 
which  line  the  air-cells  of  the  lungs,  and  uniting  with  the  in- 
flammable part  of  the  blood  generates  an  acid,  probably  the 
phosphoric  acid;  a portion  of  carbonic  acid  , is  likewise  produced 
in  this  process;  as  appears  by  repeatedly  breathing  over  lime 
water,  which  then  becomes  turbid.  See  Botanic  Garden,  P.  I. 
C.  I.  1.  401.  note. 

3.  Sternutatio.  Sneezing  consists  of  muscular  actions  pro- 
duced by  the  sensorial  faculty  of  sensation;  and  is  an  effort  to 
dislodge,  by  means  of  air  forcibly  impelled  through  the  nostrils, 
some  material;  which  stimulates  the  membrane,  which  lines 


Giass  II.  1.  1.  4.  OF  SENSATION.  153 

them,  into  too  great  action,  and  might  thence  injure  the  sense 
of  smell  which  is  diffused  on  it. 

In  this  operation  the  too  great  action  of  the  vessels  of  the 
membrane  of  the  nostrils  is  the  remote  cause  ; the  sensation 
thence  induced  is  the  proximate  cause;  and  the  muscular  ac- 
tions are  the  proximate  effect. 

This  action  of  sneezing  frequently  precedes  common  respira- 
lion  in  new-born  children,  but  I believe  not  always;  as  likethe 
latter  it  cannot  have  been  previously  acquired  in  the  uterus. 

It  is  produced  in  some  people  by  sudden  light,  as  by  looking 
up  at  the  sky  in  a morning,  when  they  come  out  of  a gloomy 
bed-chamber.  It  then  becomes  an  associate  action,  and  belongs 
to  Class  IV.  1.  2.  2. 

M.  M.  When  it  is  exerted  to  excess  it  may  be  cured  by 
snuffing  starch  up  the  nostrils.  See  Class  I.  1.  2.  13. 

4.  JlnheUtus.  Panting.  The  quick  and  laborious  breathing 
of  running  people,  who  are  not  accustomed  to  violent  exercise, 
is  occasioned  by  the  too  great  conflux  of  blood  to  the  lungs.  As 
the  sanguiferous  system,  as  wrell  as  the  absorbent  system,  is  fur- 
nished in  many  parts  of  its  course  w’ith  valves,  which  in  general 
prevent  the  retrograde  movement  of  their  contained  fluids;  and 
as  all  these  vessels,  in  some  part  of  their  course,  lie  in  contact 
with  the  muscles,  which  are  brought  into  action  in  running,  it 
follows  that  the  blood  must  be  accelerated  by  the  intermitted 
sw'elling  of  the  bellies  of  the  muscles  moving  over  them. 

The  difficulty  of  breathing,  with  which  very  fat  people  are 
immediately  affected  on  exercise,  is  owdng  to  the  pressure  of  the 
accumulated  fat  on  the  veins,  arteries,  and  lymphatics;  and 
which,  by  distending  the  skin,  occasions  it  to  act  as  a tight  ban- 
dage on  the  whole  surface  of  the  body.  Hence  when  the  mus- 
cles are  excited  into  quicker  action,  the  progress  of  the  blood  in 
the  veins,  and  of  the  lymph  and  chyle  in  the  absorbent  system, 
is  urged  on  with  much  greater  force,  as  under  an  artificial  ban- 
dage on  a limb,  explained  in  Art.  IV.  2.  10.  and  in  Sect. 
XXXIII.  3.  2.  Hence  the  circulation  is  instantly  quickened  to 
a great  degree,  and  the  difficulty  of  breathing  is  the  consequence 
of  a more  rapid  circulation  through  the  lungs.  The  increased 
secretion  of  the  perspirable  matter  is  another  consequence  of  this 
rapid  circulation;  fat  people,  wdien  at  rest,  are  believed  to  per- 
spire less  than  others,  which  may  be  gathered  from  their  generally 
having  more  liquid  stools,  more  and  paler  urine,  and  to  their 
frequently  taking  less  food  than  many  thin  people;  and  lastly, 
from  the  perspiration  of  fat  people  being  generally  more  inodo- 
rous than  that  of  lean  ones;  but  when  corpulent  people  are  put 
in  motion,  the  sweat  stands  in  drops  on  their  skins,  and  they 

VOL.  II.  x 


154 


DISEASES 


Class  II.  1.  1.  5, 


“ lard  the  ground”  as  they  run.  The  increase  of  heat  of  corpulent 
people  on  exercise,  is  another  consequence  of  their  more  rapid 
circulation,  and  greater  secretion.  See  Class  I.  2.  3.  17. 

Other  causes  of  difficult  or  quick  respiration  will  be  treated 
of  under  Asthma,  Pertussis,  Peripneumonia,  Tonsillitis. 

5.  Tussis  ebriorum.  Sensitive  cough  is  an  exertion  of  the 
muscles  used  in  expiration  excited  into  more  violent  action  by 
the  sensorial  power  of  sensation,  in  consequence  of  something 
which  too  powerfully  stimulates  the  lungs.  As  the  saline  part 
of  the  secreted  mucus,  when  the  absorption  of  it  is  impeded;  or 
the  too  great  viscidity  of  it,  when  the  absorption  is  increased; 
or  the  too  great  quantity  of  the  mucus,  when  the  secretion  is 
increased;  or  the  inflammation  of  the  membranes  of  the  lungs: 
it  is  an  effort  to  dislodge  any  of  these  extraneous  materials. 

Of  this  kind  is  the  cough  which  attends  free-drinkers  after  a 
debauch;  it  consists  of  many  short  efforts  to  cough  with  a fre- 
quent expuition  of  half  a tea-spoonful  of  frothy  mucus,  and  is 
attended  with  considerable  thirst.  The  thirst  is  occasioned  by 
the  previous  dissipation  of  the  aqueous  parts  of  the  blood  by  sen- 
sible or  insensible  perspiration;  which  was  produced  by  the  in- 
creased action  of  the  cutaneous  and  pulmonary  capillaries  during 
the  stimulus  of  the  wine.  In  consequence  of  this  an  increased 
absorption  commences  to  replace  this  moisture,  and  the  skin  and 
mouth  become  dry,  and  the  pulmonary  mucus  becomes  inspis- 
sated; which  stimulates  the  bronchia,  and  is  raised  into  froih  by 
the  successive  currents  of  air  in  evacuating  it.  This  production 
of  froth  is  called  by  some  free-drinkers  u spitting  sixpences”  af- 
ter a debauch.  This  subsequent  thirst,  dry  mouth,  and  viscid 
expectoration  in  some  people  succeeds  the  slightest  degree  of  in- 
toxication, of  which  it  may  be  esteemed  a criterion.  See  Class 
IV.  2.  1.8. 

As  coughs  are  not  always  attended  with  pain,  the  muscular 
actions  which  produce  them,  are  sometimes  excited  by  the  sen- 
sorial faculty  of  irritation,  as  in  Class  I.  1.  2.  8.  I.  1.  3.  4. 
I.  1.  4.  3.  I.  2.  3.  4.  Coughs  are  also  sometimes  convulsive, 
as  in  Class  III.  1.  1.  10.  and  sometimes  sympathetic,  as  in  Class 
IV.  2.  1.  7. 

M.  M.  Venesection,  when  the  cough  is  attended  with  in- 
flammation. Mucilages.  Opium.  Torpentia.  Blister.. 

6.  Singultus.  Hiccough  is  an  exertion  of  the  muscles  used 
in  inspiration  excited  into  more  violent  action  by  the  sensorial 
power  of  sensation,  in  consequence  of  something  which  too  pow- 
erfully stimulates  the  cardia  ventriculi,  or  upper  orifice  of  the 
stomach.  As  when  solid  food  is  too  hastily  taken  without  suf- 
ficient dilution.  And  is  an  effort  to  dislodge  that  offensive  ma- 


OF  SENSATION. 


Class  II.  1. 1.  7. 


155 


terial,  and  push  it  to  some  less  sensible  part  of  the  stomach,  or 
into  the  middle  of  the  contained  aliment. 

At  the  end  of  fatal  fevers  it  may  arise  from  the  acrimony  of 
the  undigested  aliment,  or  from  a part  of  the  stomach  being 
already  dead,  and  by  its  weight  or  coldness  affecting  the  surviv- 
ing part  with  disagreeable  sensation.  The  pain  about  the  upper 
orifice  of  the  stomach  is  the  proximate  cause,  the  too  great  or  too 
little  action  of  the  fibres  of  this  part  of  the  stomach  is  the  remote 
cause,  the  action  of  the  muscles  used  in  inspiration  is  the  proxi- 
mate effect,  and  the  repercussion  of  the  offending  material  is  the 
remote  effect. 

Hiccough  is  sometimes  sympathetic,  occasioned  by  the  pain 
of  gravel  in  the  kidney  or  ureter,  as  in  Class  IV.  1.  1.7.  and  is 
sometimes  a symptom  of  epilepsy  or  reverie,  as  in  Sect.  XIX.  2. 

M.  M.  Oil  of  cinnamon  from  one  drop  gradually  increased  tQ 
ten,  on  sugar,  or  on  chalk.  Opium.  Blister.  Emetic. 

7.  Crapula  ventriculi.  Indigestible  substances  in  the  stomach. 
This  frequently  occurs  in  children,  who  are  restrained  by  their 
ill-active  friends  from  fruit  or  other  sweet  things;  and  thus  the 
rational  mind  is  taught  to  superintend  the  satiety  of  the  sensation 
of  the  sense  of  hunger,  or  of  the  pleasure  of  the  palate,  which 
is  contrary  to  nature,  and  a much  more  erroneous  guide.  Hence 
children  are  liable  to  swallow  more  plums  and  cherries  than 
their  stomachs  can  digest;  and  if  these  run  hastily  into  fermenta- 
tion, much  air,  or  gas,  is  generated;  and  produces  an  incon- 
venient distention  of  the  stomach,  as  well  as  a disagreeable  sensa- 
tion, which  generally  terminates  in  ejecting  the  offending  matter 
by  vomiting. 

In  cows  which  have  eaten  too  much  young  clover,  the  saccha- 
rine and  mucilaginous  matter,  which  it  contains,  runs  into  so 
violent  fermentation  as  by  distention  to  destroy  the  animal. 
Whence  it  has  been  customary  with  some  to  perforate  the  first 
stomach,  and  thus  let  out  the  air.  Dr.  White,  of  Edinburgh, 
asserted,  that  he  witnessed  about  twenty  beasts  in  this  situation, 
two  were  dead  before  the  medicine  could  be  administered,  but 
to  the  other  eighteen  he  directed  half  a pint  of  spirits,  called  gin 
or  whisky,  mixed  with  as  much  water,  to  be  given;  and  they  all 
parted  with  much  air  by  eructation,  and  recovered.  An  ingenious 
gentleman  has  lately  put  a flexible  pipe  down  the  oesophagus  into 
the  distended  stomach  of  these  animals  with  certain  success,  as 
related  in  some  late  publication.  A flexible  tube  for  this  pur- 
pose might  be  made  of  wire  wrapped  round  a stick  about  half  an 
inch  in  diameter,  and  afterwards  covered  with  leather. 

A boy  about  S years  old  swallowed  a halfpenny,  which  was 
believed  to  pass  through  him  at  school,  some  weeks  afterwards, 


156 


.DISEASES 


Class  II  1.1.  8. 


but  be  has  not  recovered  his  health.  I was  informed,  that  an 
idiot  had  swallowed  a half-crown  piece,  and  directed  crude  quick- 
silver to  be  given  him  in  repeated  quantities,  but  never  heard 
the  event  of  the  case. 

A lady  in  my  presence  was  eating  a custard  out  of  a tea-cup, 
and  put  3 or  4 pins  into  her  mouth,  which  were  supposed  to 
have  been  carelessly  left  in  the  cup,  and  swallowed  one  of  them: 
now,  though  needles  have  found  their  way  out  of  the  body,  and 
other  sharp  indigestible  materials,  yet  pins  being  terminated 
with  heads  are  said  often  to  have  occasioned  dangerous  and  pain- 
ful diseases,  and  sometimes  death.  What  then  should  be  doner 
It  occurred  to  me,  that  as  the  head  of  the  pin  would  have  so 
much  greater  friction  than  the  point,  that  if  it  was  carried  for- 
wards by  a stream  of  mucilaginous  fluid,  the  bead  must  go  first; 
and  I therefore  immediately  directed  an  emetic,  and  the  pin  was 
brought  up  without  any  pain,  or  any  stains  of  blood  in  the  ejected 
fluid. 

8.  Asthma  humorale.  The  humoral  asthma  probably  consists 
in  a temporary  anasarca  of  the  lungs,  which  may  be  owing  to  a 
temporary  defect  of  lymphatic  absorption.  Its  cause  is  never- 
theless at  present  very  obscure,  since  a temporary  deficiency  ol 
venous  absorption,  at  the  extremities  of  the  pulmonary  or  bron- 
chial veins,  might  occasion  a similar  difficulty  of  respiration.  See 
Abortio,  Class  1.  2.  1.  14.  Or  it  might  be  supposed,  that  the 
lymph  effused  into  the  cavity  of  the  chest  might,  by  some  addi- 
tional heat  during  sleep,  acquire  an  aerial  form,  and  thus  com- 
press the  lungs;  and  on  this  circumstance  the  relief,  which  these 
patients  receive  from  cold  air,  would  be  readily  accounted  for. 

The  paroxysms  attack  the  patient  in  his  first  sleep,  when  the 
circulation  through  the  lungs  in  weak  people  wants  the  assistance 
of  the  voluntary  power.  Class  1.  2.  1.  3.  And  hence  the  ab- 
sorbents of  the  lungs  are  less  able  to  fulfil  the  rvhole  of  their  duty. 
And  part  of  the  thin  mucus,  which  is  secreted  into  the  air-cells, 
remains  there  unabsorbed,  and  occasions  the  difficult  respiration, 
which  awakes  the  patient.  And  the  violent  exertions  of  the 
muscles  of  respiration,  which  succeed,  are  excited  by  the  pain  of 
suffocation,  for  the  purpose  of  pushing  forwards  the  blood  through 
the  compressed  capillaries,  and  to  promote  the  absorption  of  the 
effused  lymph. 

In  this  the  humoral  differs  from  the  convulsive  asthma,  treat- 
ed of  in  Class  III.  1.  1.  10.  as  in  that  there  is  probably  no  ac- 
cumulated fluid  to  be  absorbed;  and  the  violent  respiration  is 
only  an  exertion  for  the  purpose  of  relieving  pain,  either  in  the 
lungs  or  in  some  distant  part,  as  in  other  convulsions,  or  epilepsy: 
and  in  this  respect  the  fits  of  humoral  and  convulsive  asthma 


OF  SENSATION. 


Class  II.  1. 1.  8. 


157 


essentially  differ  from  each  other,  contrary  to  the  opinion  ex- 
pressed without  sufficient  consideration  in  Sect.  XVIII.  15. 

The  patients  in  the  paroxysms  both  of  humoral  and  convul- 
sive asthma  find  relief  from  cold  air,  as  they  generally  rise  out 
of  bed,  and  open  the  window,  and  put  out  their  heads;  for  the 
lungs  are  not  sensible  to  cold,  and  the  sense  of  suffocation  is 
somewhat  relieved  by  there  being  more  oxygen  contained  in  a 
given  quantity  of  cold  fresh  air,  than  in  the  warm  confined  air 
of  a close  bed-chamber. 

I have  seen  humoral  asthma  terminate  in  confirmed  anasarca 
and  destroy  the  patient,  who  had  been  an  excessive  drinker  of 
spirituous  potation.  And  M.  Savage  asserts,  that  this  disease 
frequently  terminates  in  diabetes;  which  seems  to  shew,  that  it 
is  a temporary  dropsy  relieved  by  a great  flow  of  urine.  Add  to 
this,  that  these  paroxysms  of  the  asthma  are  themselves  relieved 
by  profuse  sweats  of  the  upper  parts  of  the  body,  as  explained 
in  Class  I.  3.  2.  8.  which  would  countenance  the  idea  of  their 
being  occasioned  by  congestions  of  lymph  in  the  lungs. 

The  congestion  of  lymph  in  the  lungs  from  the  defective  ab- 
sorption of  it  is  probably  the  remote  cause  of  humoral  asthma; 
but  the  pain  of  suffocation  is  the  immediate  cause  of  the  violent 
exertions  in  the  paroxysms.  And  whether  this  congestion  of 
lymph  in  the  air-cells  of  the  lungs  increases  during  our  sleep,  as 
above  suggested,  or  not;  the  pain  of  suffocation  will  be  more  and 
more  distressing  after  some  hours  of  sleep,  as  the  sensibility  to 
internal  stimuli  increases  during  that  time,  as  described  in  Sect. 
XVIII.  15.  For  the  same  reason  many  epileptic  fits,  and  pa- 
roxysms of  the  gout,  occur  during  sleep.  ' 

In  two  gouty  cases,  complicated  with  jaundice,  and  pain,  and 
sickness,  the  patients  had  each  of  them  a shivering  fit,  like  the 
commencement  of  an  ague,  to  the  great  alarm  of  their  friends; 
both  which  commenced  in  the  night,  I suppose  during  their 
sleep;  and  the  consequence  was  a cessation  of  the  jaundice,  and 
pain  about  the  stomach,  and  sickness;  and  instead  of  that  the 
gout  appeared  in  their  extremities.  In  these  cases  I conjecture, 
that  there  was  a metastasis  not  only  of  the  diseased  action  from 
the  membranes  of  the  liver  to  those  of  the  foot;  but  that  some  of 
the  new  vessels,  or  new  fluids,  which  were  previously  produced 
in  the  inflamed  liver,  were  translated  to  the  feet  during  the  cold 
fit,  by  the  increased  absorption  of  the  hepatic  lymphatics,  and  by 
the  retrograde  motions  of  those  of  the  affected  limbs. 

This  I think  resembles  in  some  respects  a fit  of  humoral  asth- 
ma, where  stronger  motions  of  the  absorbent  vessels  of  the  lungs- 
are  excited,  and  retrograde  ones  of  the  correspondent  cutaneous 
lymphatics;  whence  the  violent  sweats  of  the  upper  parts  of  the 


158 


U1SEASES 


Class  II.  1.  1.  9. 


body  only  are  produced;  and  for  a time  the  patient  becomes  re- 
lieved by  the  metastasis  and  elimination  of  the  offending  material 
by  sensitive  exertion.  For  a further  account  of  this  intricate 
subject  see  Class  III.  1.  1.  10. 

M.  M.  To  relieve  the  paroxysm  a tea-spoonful  of  ether  may 
be  given  mixed  with  water,  with  10  drops  of  laudanum,  to  be 
repeated  three  or  four  times.  Venesection.  An  emetic.  A 
blister.  Afterwards  the  Peruvian  bark;  with  a grain  of  opium 
at  night,  and  two  or  three  of  aloes.  A flannel  shirt  in  winter 
but  not  in  summer.  Issues.  Digitalis? 

In  this  species  of  asthma,  there  is  great  reason  to  believe,  that 
the  respiration  of  an  atmosphere,  with  an  increased  proportion  of 
oxygen,  will  prove  of  great  advantage;  some  well  observed  and 
well  attested  cases  of  which  are  published  by  Dr.  Beddoes;  as 
this  purer  air  invigorates  the  circulation,  and  the  ivhole  system 
inconsequence,  perhaps  not  only  by  its  stimulus,  but  by  its  sup- 
plying the  material  from  which  the  sensorial  power  is  extracted 
or  fabricated.  In  spasmodic  asthma,  on  the  contrary,  Dr.  Fer- 
riarhas  found  undoubted  benefit  from  an  atmosphere  mixed  with 
hydrogen.  See  Sect.  XVIII.  15.  and  Class  III.  1.  1.  10. 

9.  Nictilatio  sensitive u Winking  of  the  eyes  is  performed 
every  minute,  without  our  attention,  for  the  purpose  of  diffusing 
the  tears  over  them,  which  are  poured  into  the  eye  a little  above 
the  external  cornet  of  it,  and  which  are  aftenvards  absorbed  by 
the  lachrymal  points  above  and  below  the  internal  corner  of  it. 
When  this  operation  is  performed  without  our  attention,  it  is 
caused  by  the  faculty  of  irritation,  and  belongs  to  Class  I.  1.4. 
1.  but  when  it  is  produced  by  a stronger  stimulus  of  any  extra- 
neous material  in  the  eye,  so  as  to  cause  pain,  the  violent  and  fre- 
quent nictitation  is  caused  by  the  facully  of  sensation. 

This  disease  is  sometimes  produced  by  the  introversion  of  the 
edge  of  the  lower  eyelid,  which  bends  the  points  of  the  hairs  of 
the  eyelash  upon  the  ball  of  the  eye,  which  perpetually  stimulate 
it  into  painful  sensation.  This  introversion  of  the  eyelid  is  ge- 
nerally owing  to  a tumour  of  the  cellular  membrane  below  the 
edge  of  the  eyelid,  and  though  a very  troublesome  complaint  may 
often  be  cured  by  the  following  simple  means.  A little  common 
plaster  spread  on  thin  linen,  about  a quarter  of  an  inch  long, 
must  be  rolled  up  so  as  to  be  about  the  size  of  a crow-quill;  this 
must  be  applied  immediately  below  the  eyelash  on  the  outside  of 
the  eye,  and  must  be  kept  on  by  another  plaster  over  it.  This 
will  then  act  as  a slight  compression  on  the  tumour  under  the 
eyelash,  and  will  prevent  the  hairs  from  touching  the  eyeball. 
In  a week  or  two  the  compression  will  diminish  the  tumour  it 
lies  over,  and  cure  this  painful  deformity. 


Class  II.  1.  1.  10. 


OF  SENSATION. 


159 


10.  Oscitatio  el  pandiculatio.  Yawning  and  stretching  of  the 
limbs  is  produced  either  by  a long  inactivity  of  the  muscles  now 
brought  into  action,  as  sometimes  happens  after  sleep,  or  after 
listening  a long  time  to  a dull  narrative;  or  it  is  produced  by  a 
too  long  continued  action  of  the  antagonist  muscles.  In  the 
former  case  there  is  an  accumulation  of  sensorial  power  during 
the  quiescence  of  the  muscles  now  brought  into  action;  which 
probably  constitutes  the  pain  or  wearisomeness  of  a continued 
attitude.  In  the  latter  case  there  is  an  exhaustion  of  sensorial 
power  in  the  muscles,  which  have  lately  been  acting  violently, 
and  a consequent  accumulation  in  the  muscles,  which  are  antago- 
nists to  them,  and  which  were  at  rest. 

These  involuntary  motions  are  often  seen  in  paralytic  limbs, 
w’hich  are  at  the  same  time  completely  disobedient  to  the  wall; 
and  are  frequently  observable  in  very  young  children;  and  from 
thence  we  may  conclude,  that  these  motions  are  learnt  before  na- 
tivity; as  puppies  are  seen  to  open  their  mouths  before  the  mem- 
branes are  broken.  See  Sect.  XVI.  2. 

Where  these  motions  are  observed  in  limbs  otherwise  paraly- 
tic, it  is  an  indication  that  electric  shocks  may  be  employed  with 
advantage,  as  the  excitability  of  the  limb  by  irritation  is  not  ex- 
tinct, though  it  be  disobedient  both  to  volition  and  sensation. 

11.  Tenesmus  consists  in  violent  and  frequent  ineffectual  ef- 
forts to  discharge  the  contents  of  the  rectum,  owing  to  pain  of  the 
sphincter.  The  pain  is  produced  by  indurated  feces,  or  by  some 
acrid  material,  as  the  acidity  of  indigested  aliment;  and  the  ef- 
forts are  attended  with  mucus  from  the  pained  membrane.  The 
feces  must  sometimes  be  taken  away  by  the  end  of  a marrow- 
spoon,  as  cathartics  and  even  clysters  will  pass  without  removing 
them.  It  is  sometimes  caused  by  sympathy  with  the  urethra, 
when  there  is  a stone  at  the  neck  of  the  bladder.  See  Class  II. 
2.  2.  7.  and  IV.  1.  2.  8. 

M.  M.  Fomentation,  an  enema  with  mucilage  and  laudanum. 

The  common  exclusion  of  the  feces  from  the  rectum  is  a pro- 
cess similar  to  this,  except  that  the  muscles  of  the  sphincter  ani, 
and  those  of  the  abdomen,  which  act  along  with  them  by  the 
combined  powers  of  sensation  and  association,  are  in  tenesmus 
excited  by  painful  sensation,  and  in  the  latter  by  a sensation, 
which  may  in  some  instances  be  almost  called  pleasurable,  as  re- 
lieving us  from  a painful  one  in  the  exclusion  of  the  feces. 

12.  Stranguria.  Strangury  consists  in  painful  efforts  to  dis- 
charge the  contents  of  the  urinary  bladder.  It  is  generally  ow- 
ing to  a stone  in  the  sphincter  of  the  bladder  ; or  to  the  inflam- 
mation of  the  neck  of  it  occasioned  by  cantharides.  It  is  some- 
times caused  by  sympathy  with  the  piles:  and  then  is  liable  in 


160 


DISEASES 


Class  11.  1.  1.  13. 


women  to  occasion  convulsions,  from  the  violence  of  the  pain 
without  inflammation.  See  Class  IV.  2.  2.  2.  and  3. 

M.  M.  Fomentation  clyster  with  oil  and  laudanum,  push  the 
stone  back  with  a bougie;  if  from  cantharides,  give  half  a pint  of 
warm  water  every  ten  minutes.  Mucilage  of  gum  and  traga- 
canth. 

The  natural  evacuation  of  the  urine  is  aprocess  similar  to  this, 
except  that  the  muscular  fibres  of  the  bladder,  and  the  muscles 
of  the  abdomen,  which  act  in  concert  with  them  by  the  combin- 
ed powers  of  sensation  and  of  association,  are,  in  the  former  case 
of  strangury,  excited  into  action  by  painful  sensation;  and  in  the 
latter  by  a sensation,  which  may  almost  be  termed  pleasurable, 
as  it  relieves  us  from  a previous  uneasy  one. 

The  ejectio  seminis  is  another  process  in  some  respects  similar 
to  strangury,  as  belonging  to  the  same  sensible  canal  of  the  ure- 
thra, and  by  exciting  into  action  the  acceleratory  muscles;  but 
in  the  strangury  these  muscles  are  excited  into  action  by  painful 
sensation,  and  in  the  ejection  of  the  semen  by  pleasurable  sensa- 
tion. 

13.  Parturitio.  Parturition  is  not  a disease,  it  is  a natural  pro- 
cess, but  is  more  frequently  unfortunate  in  high  life  than  amongst 
the  middle  class  of  females;  which  may  be  owing  partly  to  fear, 
with  which  the  priests  of  Lucina  are  liable  to  inspire  the  ladies 
of  fashion  to  induce  them  to  lie-in  in  town;  and  part ly  to  the  bad 
air  of  London,  to  which  they  purposely  resort. 

There  are,  however,  other  causes,  which  render  parturition 
more  dangerous  to  the  ladies  of  high  life;  such  as  their  greater 
general  debility  from  neglect  of  energetic  exercise,  their  inexpe- 
rience of  the  variations  of  cold  and  heat,  and  their  seclusion 
from  fresh  air.  To  which  must  be  added,  that  great  source  of 
the  destruction  of  female  grace  and  beauty,  as  well  as  of  female 
health,  the  tight  stays,  and  other  bandages,  with  which  they  are 
generally  tortured  in  their  early  years  by  the  active  folly  of  their 
friends,  which  by  displacing  many  of  the  viscera  impedes  their 
actions,  and  by  compressing  them  together  produces  adhesions  of 
one  part  to  another,  and  affects  even  the  form  and  aperture  of  the 
bones  of  the  pelvis,  through  which  the  nascent  child  must  be  pro- 
truded. 

As  parturition  is  a natural,  not  a morbid  process,  no  medicine 
should  be  given,  where  there  is  no  appearance  of  disease.  The 
absurd  custom  of  giving  a powerful  opiate  without  indication  to 
all  women,  as  soon  as  they  are  delivered,  is,  I make  no  doubt, 
frequently  attended  with  injurious,  and  sometimes  with  fatal  con- 
sequences. See  Class  II.  I.  2.  16. 

Another  thing  very  injurious  to  the  child,  is  the  tying  and 


Class  II.  1.  1.  13. 


OF  SENSATION. 


161 


cutting  the  navel-string  too  soon;  which  should  always  be  left 
till  the  child  has  not  only  repeatedly  breathed,  but  till  all  pulsa- 
tion in  the  cord  ceases.  As  otherwise  the  child  is  much  weaker 
than  it  ought  to  be;  a part  of  the  blood  being  left  in  the  pla- 
centa, which  ought  to  have  been  in  the  child;  and  at  the  same 
time  the  placenta  does  not  so  naturally  collapse,  and  withdraw  it- 
self from  the  sides  of  the  uterus,  and  is  not  therefore  removed  with 
so  much  safety  and  certainty.  The  folly  of  giving  rue  or  rhu- 
barb to  new-born  children,  and  the  danger  of  feeding  them  with 
gruel  instead  of  milk,  is  spoken  of  in  Class  I.  1.2.  5.  and  II.  1. 
2.  16. 

Many  ladies  become  diseased  by  an  unnatural  refusal  of  giving 
suck  to  their  child,  which  ought  to  relieve  their  breasts  of  the 
load  of  milk,  and  give  consolation  to  their  minds  by  the  storge 
or  love  to  their  infant.  Many  ladies  indeed  experience  a diffi- 
culty in  nursing  their  children  from  their  not  having  nipples  to 
their  breasts;  which  have  been  often  inflamed  and  destroyed  in 
their  early  years,  even  in  their  infancy,  as  I have  seen,  by  the 
hard  edge  of  stiff  stays  rubbing  against  them,  and  sometimes,  I 
believe,  by  the  small-pox. 

M.  Herholdt,  of  Copenhagen,  has  announced  a discovery,  which 
he  thinks  highly  interesting  to  humanity;  which  is,  that  the 
apparent  death  of  new-born  infants  arises  from  the  trachea,  or 
wind-pipe,  being  filled  with  water;  and  that  they  may  be  gene- 
rally saved  by  giving  them  such  an  inclined  position,  that  the 
water  may  run  out.  Of  thirteen  children,  which  were  supposed 
to  be  dead  or  still-born,  he  says,  that  twelve  recovered  by  these 
simple  means.  As  the  trachea  may  not  have  acquired  due  sensi- 
bility before  delivery,  in  some  feeble  or  premature  births,  this 
circumstance  may  possibly  arise,  though  it  seldom  occurs  even  in 
drowned  people.  Medical  Review,  July,  1799. 


VOL.  II. 


it 


162 


DISEASES 


Class  II.  1.  2 


ORDO  I. 

Increased  Sensation. 

GENUS  II. 

With  the  production  of  new  Vessels  by  internal  Membranes  or 
Glands , with  Fever. 

In  the  first  class  of  diseases  two  kinds  of  fevers  were  described, 
one  from  excess,  and  the  other  from  defect  of  irritation;  and 
were  in  consequence  termed  irritative,  and  inirritative  fevers. 
In  this  second  class  of  diseases  another  kind  of  fever  occurs, 
which  is  caused  by  excess  of  sensation,  and  termed  in  conse- 
quence Sensitive  Fever.  But  there  is  no  fever  from  defect  of 
sensation,  because  the  circulation  is  carried  on  in  health  without 
our  consciousness,  that  is,  without  any  sensation  attending  it. 

But  as  excess  of  sensation  may  exist  with  excess  or  defect  of 
irritation,  two  other  kinds  of  fever  arise  from  a combination  of 
sensitive  fever  with  the  irritative,  and  inirritative  ones.  Making 
five  kinds  in  all. 

1.  Irritative  fever,  described  in  Class  I.  1.  1.  1. 

2.  Inirritative  fever.  Class  I.  2.  1.  1. 

3.  Sensitive  fever.  Class  II.  1.  6.  1. 

4.  Sensitive  irritated  fever.  Class  II.  1.  2.  1. 

.5.  Sensitive  inirritated  fever.  Class  II.  1.3.  1. 

As  the  sensitive  irritated  fever  attends  all  the  diseases  enume- 
rated under  the  genus  about  to  be  described,  it  is  placed  at  the 
head  of  it.  And  as  the  sensitive  inirritated  fever  accompanies 
the  greatest  number  of  the  species  enumerated  under  the  third 
genus  of  this  order,  it  is  placed  at  the  head  of  them.  And  as 
the  sensitive  fever  attends  the  diseases  of  the  sixth  genus,  it  is 
placed  at  the  head  of  them.  But  as  every  febrile  paroxysm  con- 
sists of  disordered  tribes  or  trains  of  associated  motions,  it  may  be 
doubted,  whether  they  ought  not  all  to  have  been  placed  in  the 
fourth  class,  amongst  the  diseases  of  association.  See  Class  IV 
2.  4.  11. 

All  the  subsequent  species  of  this  genus  are  attended  with  sen- 
sitive irritated  fever;  there  are  nevertheless  some  superficial  in- 
flammations, which  affect  the  same  situations  without  much  fever, 
as  the  scrofulous  ophthalmy  and  spurious  peripueumony,  which 
belong  to  other  genera. 

Inflammation  is  uniformly  attended  with  the  production  or 
secretion  of  new  fibres  constituting  new  vessels:  (his  therefore 


Glass  II.  1.  2. 1. 


OF  SEXSATIOX. 


163 


may  be  esteemed  its  essential  character,  or  the  criterion  of  its 
existence.  The  extension  of  the  old  vessels  seems  rather  a con- 
sequence than  a cause  of  the  germination,  or  pullulation,  of  these 
new  ones;  for  the  old  vessels  may  be  enlarged,  and  excited  with 
unusual  energy,  without  any  production  of  new  ones,  as  in  the 
blush  of  shame  or  of  anger. 

When  these  new  vessels  are  formed,  if  they  are  not  reabsorbed 
into  the  circulation,  they  secrete  a new  fluid  called  purulent  mat- 
ter; which  generally  opens  itself  a passage  on  the  external  skin, 
and  produces  an  ulcer,  which  either  gradually  heals,  or  spreads, 
and  is  the  cause  of  hectic  fever;  or  they  secrete  contagious  mat- 
ter, which  has  the  property  of  exciting  the  same  kind  of  inflam- 
mation, and  of  producing  the  same  kind  of  contagious  matter, 
when  inserted  by  inoculation  into  the  skin  of  other  persons. 
These  contagious  matters  form  ulcers,  which  either  heal  sponta- 
neously, or  by  art;  or  continue  to  spread,  and  destroy  the  pa- 
tient, by  other  kinds  of  hectic  fever. 

In  this  genus  there  is  an  increase  of  the  sensorial  power  of  ir- 
ritation as  well  as  of  sensation;  whence  great  arterial  energy  is 
produced,  and  the  pulse  becomes  strong  and  full,  as  well  as  quick; 
and  the  coats  of  the  arteries  feel  hard  under  the  finger,  being 
themselves  thickened  and  distended  by  inflammation.  The  blood 
drawn,  especially  at  the  second  bleeding,  is  covered  with  a tough 
size;  which  is  probably  the  mucus  from  the  inflamed  internal 
surface  of  the  arteries,  increased  in  quantity,  and  more  coagulable 
than  in  its  natural  state;  the  thinner  part  being  mere  perfectly 
absorbed  by  the  increased  action  of  the  inflamed  absorbents.  See 
Sect.  XXXIII.  2.  2.  This  is  rendered  more  probable,  because 
the  hard  feel  of  the  pulse,  and  the  abundance  of  coagulable 
lymph  commence,  exist,  and  cease  together. 

Great  heat  is  produced  from  the  new  chemical  combinations 
arising  in  the  secretion  of  new  fibres,  and  great  pain  from  the 
distention  of  old  ones,  or  from  their  increased  action.  The  in- 
creased quantity  of  sensation  from  a topical  inflammation  or 
phlegmon  is  the  immediate  cause  of  the  febris  sensitiva  irritata, 
or  inflammatory  fever;  as  when  it  arises  from  the  pain  of  pleu- 
risy, or  paronychia;  but  generally  an  irritative  fever  precedes 
this  topical  inflammation,  which  occurs  during  the  hot  fit  of  it; 
and  then  the  irritative  fever  is  changed  into  a sensitive  irritated 
fever,  by  the  additional  cause  of  the  sensorial  power  of  sensation 
besides  that  of  irritation. 

SPECIES. 

1.  Febris  sensitiva  irritata.  Sensitive  irritated  fever,  or  in- 


164 


DISEASES 


Class  II.  1.2.  1 


flammatory  fever.  Phlegmasia.  A strong  full  pulse,  with  in- 
flammation of  the  coats  of  the  arteries,  constitutes  this  disease. 
It  originates  from  some  topical  inflammation,  which,  if  the  fever 
is  not  subdued,  terminates  in  suppuration;  and  differs  from  irri- 
tative fever  in  respect  to  the  painful  sensation  which  accompa- 
nies it.  For  as  pleasurable  sensation  is  the  cause  of  the  growth 
of  the  new  vessels  and  distention  of  the  old  ones,  in  the  natu- 
ral enlargement  of  the  body  during  our  infancy;  so  a painful  sen- 
sation is  the  cause  of  the  unnatural  production  of  new  vessels, 
and  enlargement  of  old  ones  in  inflammatory  diseases. 

When  matter  is  thus  formed  in  any  internal  viscus,  or  in  the 
cellular  membrane,  as  in  the  lungs  or  liver;  so  long  as  this  ab- 
scess remains  without  admission  of  air,  this  inflammatory  fever 
is  liable  to  continue,  receiving  only  temporary  relief  by  bleeding 
or  emetics,  or  cathartics;  till  the  patient,  after  a mouth,  or  two, 
or  three,  expires.  But  if  the  air  be  admitted  to  these  internal  ab- 
scesses, this  kind  of  fever  is  changed  into  a hectic  fever  in  a single 
day.  It  also  sometimes  happens,  that  when  the  abscess  remains 
unopened  to  the  air,  if  the  matter  has  become  putrid,  hectic  fever 
supervenes,  with  colliquative  srveats,  or  diarrhoea;  the  matter  in 
both  cases  is  sometimes  absorbed,  and  the  sides  of  the  abscess 
grow  together  again  without  an  external  aperture.  See  Class 
II.  1.4.  1.  and  2.  Another  termination  of  inflammation  is  in 
gangrene,  but  this  belongs  to  the  inflammation  of  the  external 
skin;  as  the  production  of  purulent  matter  belongs  to  inflamma- 
tion of  the  internal  or  mucous  membranes.  Thus  when  the  ex- 
ternal skin  is  the  seat  of  inflammation,  as  in  erythema,  or  erysi- 
pelas, and  produces  sensitive  irritated  fever,  no  collection  of  pu- 
rulent matter  can  be  formed;  but  a material  oozes  out,  and  lies 
upon  the  surface,  like  that  in  the  confluent  small-pox,  and  the 
cuticle  at  length  peels  off,  or  gangrene  supervenes.  It  must  be 
noted,  that  these  kinds  of  inflammation  can  exist  together;  and 
some  parts  of  the  cellular  membrane  may  suppurate  at  the  same 
time  that  the  external  skin  is  affected  with  erythema,  or  erysi- 
pelas. 

M.  M.  Venesection.  Cathartics.  Diluents.  Cool  air. 
Torpentia.  Cold  bath?  See  Sect.  XII.  6. 

The  increased  arterial  action  in  this  sensitive  irritated  fever  is 
not  simply  owing  to  the  increased  irritability  of  the  arterial  sys- 
tem, or  to  the  stimulus  of  the  distention  of  the  vessels,  but  also 
to  the  increased  acrimony  or  pungency  of  the  blood;  which 
has  now  so  far  changed  its  nature  as  to  become  more  fluid, 
more  dense,  and  to  be  loaded  with  coagulablc  lymph.  Hence 
it  becomes  necessary  not  only  to  lessen  the  quantity  of  blood 
by  venesection  and  by  cathartics,  but  also  to  dilute  its  acrimony, 


Class  II.  1.  2.  2- 


OF  SENSATION. 


165 


or  pungency,  by  the  introduction  of  aqueous  and  mucilagi- 
nous fluids,  such  as  barley  water,  cream  and  water,  sugar  and 
water,  weak  broths;  to  which  may  be  added  so  much  of  some 
vegetable  essential  oil,  as  may  render  them  grateful  to  the  sto- 
mach, and  thus  promote  their  absorption;  as  by  infusing  parsley 
or  celery  and  turnips  in  the  broth;  or  by  balm,  mint,  or  sage 
teas. 

The  following  species  of  this  genus  only  distinguish  the  situa- 
tion of  the  part  previously  inflamed,  and  which  is  the  remote 
cause  of  the  sensitive  irritated,  or  inflammatory  fever,  which  at- 
tends it. 

2.  Ophthalmia  interna.  Inflammation  of  the  eye  is  attended 
with  the  production  of  new  vessels,  which  spread  over  the  tunica 
adjunctiva,  and  over  the  cornea;  these  new  vessels  are  easily 
seen,  as  they  lie  on  a white  ground,  and  give  ocular  demonstra- 
tion of  their  production  in  inflammation.  When  this  inflamma- 
tion of  the  cornea  suppurates,  it  is  liable  to  leave  little  ulcers, 
which  may  be  seen  beneath  the  surface  in  the  form  of  little  ex- 
cavations; and  as  these  heal,  they  are  liable  to  be  covered  with 
an  opaque  scar.  This  scar,  in  some  months  or  years,  is  liable  to 
wear  away,  and  become  transparent,  without  the  assistance  of 
any  polishing  powder,  as  of  very  finely  levigated  glass,  as  some 
have  recommended.  But  when  the  cornea  is  affected  through 
all  its  thickness,  the  return  of  its  transparency  becomes  hopeless. 
See  Class  I.  1.3.  14. 

In  violent  degrees  of  ophthalmy  the  internal  parts,  as  the  reti- 
na,  optic  artery,  iris,  ciliary  process,  become  inflamed,  as  well 
as  the  external  ones;  hence  the  least  light  admitted  to  the  eye 
occasions  intolerable  pain.  This  curious  circumstance  cannot 
be  owing  to  the  action  of  light  on  the  inflamed  vessels  of  the 
cornea;  it  therefore  shews,  that  the  extremity  of  the  optic  nerve 
or  retina  is  also  rendered  more  exquisitely  sensible  to  light,  by 
partaking  of  the  inflammation;  and  I have  been  told,  that  red 
colours  are  in  these  cases  sometimes  painfully  perceived  even 
in  perfect  darkness.  This  shews  that  the  retina  is  excited  into 
motion  by  the  stimulus  of  light;  and  that,  when  it  is  inflamed, 
these  motions  give  great  pain,  like  those  of  other  inflamed  parts, 
as  the  muscles  or  membranes.  And  secondly,  that  the  ideas 
of  colours  consist  in  the  motions  of  the  retina;  which  ideas 
oecasion  tpain,  when  the  extremity  of  the  moving  nerve  is  in-r 
flamed. 

M.  M.  Venesection.  Cathartics.  Diluents.  Torpentia. 
Frequently  moisten  the  eye  with  cold  water  by  means  of  a rag. 
Cool  airy  room.  Darkness.  When  the  inflammation  begins  to 
decline,  white  vitriol  gr.  vi,  in  an  ounce  of  water  is  more  effica- 


166 


DISEASES 


Class  II.  1.  2.  3. 

cious  to  mosten  the  eye  than  solutions  of  lead.  Tincture  of 
opium  diluted.  Extract  of  belladonna.  New  vessels  from  the 
inflamed  tunica  adnata  frequently  spread  like  a fly’s  wing  upon 
the  transparent  cornea,  which  is  then  called  Pterigium.  To 
stop  the  growth  of  this,  the  principal  vessels  should  be  cut  through 
with  a lancet.  When  the  inflammation  begins  to  decline,  after 
due  evacuation  any  stimulating  material  put  into  the  eye  increases 
the  absorption,  which  soon  removes  the  new  red  vessels;  which 
has  given  rise  to  a hundred  famous  eye-waters,  and  eye-doctors;  if 
these  stimulating  materials  are  used  too  soon,  the  inflammation 
is  increased  by  them.  See  Sect.  XXXII.  2.  10.  Class  I.  2. 

2.  13. 

There  is  another  ophthalmia,  which  attends  weak  children, 
and  is  generally  esteemed  a symptom  of  scrofula,  as  described  in 
Class  II.  1.  5.  3.  and  another,  which  is  of  venereal  origin, 
mentioned  in  Class  II.  1.5.  2.  both  which  maybe  termed  oph- 
thalmia superficialis. 

3.  Plirenitis.  Inflammation  of  the  brain  is  attended  with  in- 
tolerance of  light  and  sound;  which  shews,  that  the  extremities 
of  the  nerves  of  those  senses  are  at  the  same  time  inflamed;  it  is 
also  attended  with  great  pain  of  the  head,  with  watchfulness,  and 
furious  delirium.  The  violent  efforts  these  patients  are  said 
sometimes  to  exert,  are  owing  to  the  increased  secretion  of  sen- 
sorial power  in  the  brain;  as  all  other  inflamed  glands  have  a 
greater  circulation  of  blood  passing  through  them,  and  a greater 
secretion  in  consequence  of  their  peculiar  fluids,  as  in  the  hepa- 
titis much  more  bile  is  generated. 

M.  M.  Venesection.  Cathartics.  Torpentia.  Foment  the 
head  with  cold  water  for  hours  together.  Or  with  warm  water. 
Cool  airy  room.  Afterwards  cupping  on  the  occiput.  Leeches 
to  the  temples.  When  the  patient  is  weakened  a blister  on  the 
head,  and  after  further  exhaustion  five  or  six  drops  of  tincture  of 
of  opium. 

4.  Peripneumonia.  Inflammation  of  the  lungs.  The  pulse  is 
not  always  hard,  sometimes  soft;  which  is  probably  owing  to  a 
degree  of  sickness  or  inaction  of  the  stomach;  with  dull  pain  of 
the  chest;  respiration  constantly  difficult,  sometimes  with  erect 
posture;  the  face  bloated  and  purplish;  cough  generally  with 
moist  expectoration,  often  stained  with  blood. 

When  the  difficulty  of  respiration  is  very  great,  the  patient  is 
not  able  to  cough;  in  this  situation,  after  copious  bleeding,  the 
cough  is  liable  to  return,  and  is  so  far  a favourable  symptom,  as 
it  shews  some  abatement  of  the  inflammation. 

A peripneumony  frequently  occurs  in  the  chin-cough,  and 
destroys  the  patient,  except  immediate  recourse  be  had  to 


Class  II.  1. 2.4.  OF  SENSATION.  167 

the  lancet,  or  to  four  or  five  leeches;  when  blood  cannot  be 
otherwise  taken. 

The  peripneumony  is  very  fatal  to  young  children,  especially 
as  I believe  it  is  frequently  mistaken  for  a spasmodic  asthma,  or 
for  the  croup,  or  cynanche  trachealis  of  Cullen.  Both  which, 
however,  when  they  occur,  require  immediate  venesection  by 
the  lancet  or  by  leeches,  as  well  as  the  peripneumony;  as  men- 
tioned below. 

Inflammation  of  the  lungs  is  also  liable  to  occur  in  the  measles, 
and  in  the  hooping-cough,  and  must  be  attacked  by  venesection 
at  any  time  of  the  disease;  otherwise  either  a present  death,  or 
an  incurable  consumption,  is  the  consequence. 

The  peripneumony  is  frequently  combined  with  inflammation 
of  the  pleura,  and  sometimes  with  that  of  the  diaphragm;  either 
of  these  may  generally  be  distinguished,  not  only  by  the  pain 
which  attends  inflammation  of  these  membranes,  but  by  inspect- 
ing the  naked  chest,  and  observing  whether  the  patient  breathes 
more  by  elevating  the  ribs,  or  by  depressing  the  diaphragm. 

A crisis  happens  in  children  about  the  sixth  day  with  much 
pale  urine,  which  must  be  waited  for  after  evacuations  have  been 
used,  as  far  as  can  be  done  with  safety;  in  this  situation  the 
warm  bath  twice  a day,  and  small  blisters  repeatedly  in  succes- 
sion, are  of  peculiar  service. 

After  the  termination  of  the  peripneumony  a collection  of  co- 
agulable  lymph  is  frequently  left  in  the  cavity  of  the  chest  unab- 
sorbed; or  a common  anasarca  of  the  lungs  occurs  from  the  pre- 
sent inaction  of  the  absorbent  vessels,  which  had  previously  been 
excited  too  violently.  This  difficulty  of  breathing  is  cured  or 
relieved  by  the  exhibition  of  digitalis.  See  Art.  IY.  2.  7. 

M.  M.  The  lancet  is  the  anchor  of  hope  in  this  disease; 
which  must  be  repeated  four  or  five  times,  or  as  often  as  the  fe- 
ver and  difficulty  of  breathing  increase,  which  is  generally  in 
the  evening;  antimonials,  diluents,  repeated  small  blisters  about 
the  chest,  mucilage,  pediluvium,  warm  bath.  Is  a decoction 
of  seneca-root  of  use?  Do  not  neutral  salts  increase  the  tendency 
to  cough  by  their  stimulus,  as  they  increase  the  heat  of  urine 
in  gonorrhoea?  Children  in  every  kind  of  difficult  breathing 
from  whatever  cause,  should  be  kept  as  upright  in  bed  as  may 
be,  and  continually  watched;  since,  if  they  slip  dowm,  they  are 
liable  to  be  immediately  suffocated:  to  prevent  which  a pilloiv 
should  be  put  beneath  the  undermost  sheet  half  way  dowm  in  the 
bed,  so  as  to  receive  the  posteriors  of  the  child,  and  thus  coun- 
teract its  sliding  down  lower;  or  drawers  on  the  thighs  might 
be  occasionally  used  for  this  purpose,  as  mentioned  in  Class  III. 
2.  1.10.  And  children  should  have  no  cap  string  tied  under 


168 


DISEASES 


CtAss  If.  1.2.  4. 


their  chins  in  any  cough  or  difficulty  of  respiration,  since  if  they 
slip  down  in  their  bed,  the  friction  of  the  night-cap  on  the  pillow 
is  liable  to  draw  the  tape  or  ribbon  under  the  chin  too  tight, 
and  suffocate  them.  After  the  patient  is  greatly  debilitated,  so 
that  no  further  evacuation  can  be  admitted,  and  the  difficult 
breathing  and  cough  continue,  I have  given  four  or  five  drops  of 
tincture  of  opium,  that  is,  about  a quarter  of  a grain  of  solid 
opium,  with  great  advantage,  and  I believe  in  several  cases  I 
have  saved  the  patient.  A greater  quantity  of  opium  in  this 
state  of  debility  cannot  be  used  without  hazarding  the  life  of  the 
person.  This  small  quantity  of  an  opiate  should  be  given  about 
six  in  the  evening,  or  before  the  access  of  the  evening  paroxysm, 
and  repeated  three  or  four  nights,  or  longer. 

There  is  a peripneumony  with  weak  pulse,  which  may  be 
termed  peripneumonia  inirritata , as  described  in  Sect.  XXVII.  2. 
which  belongs  to  this  place.  See  also  Superficial  Peripneumo* 
ny,  Class  II.  1.  3.  7. 

Peripneumonia  arthritica.  Gouty  peripneumony.  I believe, 
that  there  exists  a peripneumony,  and  pleurisy  which  owe  their 
inflammation  to  the  sympathy  of  those  membranes  with  some 
other  parts  of  the  system,  and  may  then  properly  be  termed 
rheumatic  or  gouty  peripneumony,  or  pleurisy.  And  that  the 
coagulable  lymph  left  upon  the  inflamed  membranes  has  general- 
ly been  owing  to  these  sympathetic  inflammations,  and  that  hy- 
drops thoracis,  and  anasarca  pulmonum  are  generally  caused  by 
gouty  affections  of  the  lungs;  or  rheumatic  affections  of  the  pleu- 
ra, and  not  by  the  more  common  idiopathic  inflammations  of 
those  membranes.  See  Class  I.  2.  3.  14,  and  Class  IV.  1.  2. 
16.  and  Class  IV.  1.  2.  9. 

Peripneumonia  trachealis.  Croup.  The  croup  is  an  inflam- 
mation of  the  upper  part,  and  the  peripneumonia  of  the  lower 
part  of  the  same  organ,  viz.  the  trachea  or  wind-pipe.  See 
Class  I.  1.  3.  4.  But  as  the  inflammation  is  seldom,  I believe, 
confined  to  the  upper  part  of  the  trachea  only,  but  exists  at  the 
same  time  in  other  parts  of  the  lungs;  and  as  no  inflammation  of 
the  tonsils  is  generally  perceptible,  the  uncouth  name  of  cynan- 
che  trachealis  should  be  changed  for  peripneumonia  trachealis. 

Dr.  Wichmann,  of  Hanover,  believes  that  the  acute  asthma  of 
Millar,  or  hives,  has  been  confounded  with  the  angina  polyposa, 
or  croup,  which  has  occasioned  the  great  difference  in  the  treat- 
ment recommended  by  authors;  as  the  disease  has  been  esteem- 
ed inflammatory  by  some,  and  spasmodic  by  others. 

The  convulsive  asthma,  which  I have  witnessed  in  one  child, 
was  readily  distinguished  from  the  croup;  as  there  was  simply  a 
great  exertion  in  breathing,  but  without  the  harsh  sound  which 


Ceass  II.  1.  2.  4. 


OF  SENSATION. 


169 


attends  the  inspirations  in  the  latter,  and  there  was  no  attendant 
fever;  and  the  disease  was  cured  by  one  venesection,  and  a 
moderate  dose  of  opium  after  the  venesection.  See  asthma  con- 
vulsivum.  Class  III.  1.  1.  10. 

A convulsive  difficulty  of  respiration  may  thus  be  easily  dis- 
tinguished from  the  croup;  as  in  the  former  the  patient  draws 
in  the  breath  easily,  and  then  voluntarily  closes  the  larynx,  and 
voluntarily  uses  great  exertion  in  forcing  out  the  breath,  with  de- 
sign to  relieve  some  pain  by  this  violent  exertion,  as  in  paroxysms 
of  epilepsy. 

On  the  contrary,  in  the  croup  the  breath  is  easily  expired,  but 
the  inspirations  are  attended  with  the  utmost  difficulty.  This 
difficulty  of  inspiration  may  be  seen  by  viewing  the  region  of  the 
stomach;  as  when  the  child  raises  the  sternum  for  the  purpose  of 
drawing  in  its  breath,  the  pressure  of  the  atmosphere  on  the  pit 
of  the  stomach  presses  the  diaphragm  upwards,  and  makes  a sud- 
den and  great  hollow  in  the  scrobiculus  cordis.  This  difficulty  of 
inspiration,  and  not  of  expiration,  is  also  known  by  the  harsh 
sound,  which  only  attends  the  inspiration. 

This  difficulty  of  inspiration  may  in  part  be  owing  to  this  cir- 
cumstance. In  dissecting  those  children  who  have  died  of  the 
croup,  I believe  the  upper  part  of  the  adherent  coagulable  lymph, 
or  indurated  mucus,  formed  within  the  trachea,  is  found  to  be- 
come loose,  and  to  separate  from  the  upper  part  of  the  trachea 
before  the  lower  part  of  that  adhesive  membranous  crust  begins 
to  separate,  and  hence  the  loose  upper  part  at  the  time  of  inspira- 
tion is  bent  downwards  into  the  trachea,  and  thus  becomes  dou- 
ble, and  obstructs  the  passage;  but  this  dupiicature  of  it  does  not 
happen  in  expiration.  See  Transact,  of  a Society,  Yol.  II.  Ac- 
count of  Croup,  by  Henry  Ramsey,  case  the  8th.  Might  not  this 
be  prevented  from  being  fatal,  by  an  aperture  into  the  windpipe 
beneath  the  larynx? 

I have  very  lately  seen  a most  distinct  case  of  this  peripneu- 
monia trachealis,  or  croup.  The  child,  about  ten  months  old, 
had  great  difficulty  in  drawing  in  its  breath,  with  much  noise; 
but  had  much  less  difficulty  in  its  expiration,  with  little  or  gene- 
rally no  sound.  On  observing  its  naked  chest,  the  sternum,  or 
breast-bone,  was  seen  to  be  raised  with  great  force;  and  then  the 
diaphragm,  and  the  bowels  under  it,  rose  hastily  up  into  the  lower 
part  of  the  cavity  of  the  chest;  and  the  air  rushed  with  difficulty, 
and  with  great  sound,  through  the  contracted  larynx  into  the  upper 
part  of  the  chest;  both  these  effects  were  evidently  owing  to  the 
pressure  of  the  atmosphere,  to  supply  the  vacuity,  which  must 
otherwise  succeed  the  forcibly  raising  of  the  sternum. 

Why  the  difficulty  of  inspiring  was  so  much  greater  than 
vor,  ir.  7, 


170 


DISEASES 


Glass  II.  1.  2.  4. 


of  expiring,  requires  to  be  further  explained.  During  inspira- 
tion, the  pressure  of  the  atmosphere,  when  the  cavity  of  the  chest 
is  enlarged  by  raising  the  sternum,  and  depressing  the  diaphragm, 
acts  upon  the  external  part  of  the  larynx,  as  weli  as  on  the  aper- 
ture of  it,  and  thus  contracts  it,  and  assists  the  disease;  whereas 
in  expiration  there  is  no  increase  of  atmospheric  pressure  on  the 
outside  of  the  larynx,  or  trachea,  to  prevent  the  exclusion  of  the 
air.  In  the  same  manner,  if  a flexible  pipe  of  soft  leather  was 
extended  upwards  a few  inches  through  the  bottom  of  a bucket  of 
water,  but  very  little  of  the  water  could  be  discharged  by  it;  as 
the  pressure  on  its  sides  would  soon  compress  the  pipe,  and  thus 
stop  up  its  mouth. 

After  repeated  venesection,  and  a cathartic  of  calomel,  a blister 
was  applied  on  each  side  of  the  larynx,  and  the  difficulty  of  breath- 
ing became  greatly  relieved;  and  though  the  child  had  intervals 
of  easier  respiration,  and  without  noise,  yet  it  died  on  the  suc- 
ceeding day. 

Where  the  difficulty  of  breathing  is  very  urgent  in  the  croup, 
bronchotomy  is  recommended  by  Mr.  Field.  Memoirs  of  a Medi- 
cal Society,  London,  1773,  Vol.  IV. 

After  repeated  vensection,  and  cathartics,  perhaps  a drop  or  two 
drops  of  tincture  of  opium,  about  six  in  the  evening,  might  be  of 
use  to  prevent  the  return  of  the  evening  paroxysm,  and  this  espe- 
cially if  the  difficulty  of  respiration  has  an  interval  or  remission, 
as  mentioned  below. 

A strong  decoction  of  seneca  root  is  recommended  by  Dr 
Archer,  of  America.  He  boils  half  an  ounce  of  the  root,  from 
eight  ounces  of  water  to  four,  and  gives  a tea-spoonful  every  houi 
or  half  hour,  so  as  to  produce  vomiting  or  purging,  and  then  gives 
it  in  smaller  quantities.  He  also  rubs  mercurial  ointment  about 
the  throat,  and  uses  calomel  internally,  so  as  to  affect  the  glands 
of  the  throat  as  quickly  as  possible,  when  the  disease  is  more 
advanced,  and  the  difficulty  of  breathing  with  harsh  and  shrill 
inspiration  is  more  urgent.  Medical  and  Physical  Journal,  No.  I. 
p.  83.  As  a decoction  of  seneca  root  particularly  stimulates 
some  parts  of  the  throat,  occasioning  a disagreeable  sensation  in 
it,  it  may  in  some  cases  contribute  to  loosen  or  discharge  the  adhe- 
sive coagulable  lymph,  which  has  been  secreted  on  the  inflamed 
membrane  of  the  wind-pipe,  and  occasions  the  difficulty  of  in- 
spiration by  contracting  its  aperture;  and  may  therefore  be  worth 
trial  after  repeated  venesection,  and  cathartics,  and  blisters  on 
each  side  of  the  throat. 

Dr.  Wichmann  of  Hanover,  above  mentioned,  asserts,  that  in 
the  croup  the  disease  continues  regularly  to  increase,  from  the 
commencement  of  it,  without  intervals  of  relief  from  the  great 


Class.  II.  1.  2.  5. 


OF  SENSATION, 


171 


difficulty  of  breathing;  and  gives  this  as  a criterion  to  distinguish 
the  angina  polyposa  from  the  asthma  acutum.  Annals  of  Medi- 
cine, Vol.  I.  But  in  the  cases  of  true  croup,  peripneumonia 
trachealis,  I have  seen  with  surprise  the  difficulty  of  respiration 
to  cease  for  a time,  and  return  again  with  unabated  violence. 
These  remissions  of  the  difficult  respiration  are  also  mentioned 
by  Dr.  Ferriar,  who  then  terms  it  a spurious  croup,  but  which 
I suspect  to  be  owing  simply  to  the  following  circumstances. 

In  a common  catarrh,  when  the  mucous  membrane  of  the 
nostrils  is  much  inflamed,  it  becomes  so  thickened  as  totally  to 
prevent  respiration  through  them;  yet  on  suddenly  warming  the 
skin,  by  drinking  tea  or  by  a fire,  and  sometimes  by  only  cooling 
the  membrane  of  the  nostrils  by  going  into  the  cold  air,  the  swel- 
ling of  this  membrane  will  suddenly  subside,  so  as  to  permit  the 
air  to  pass  through  quite  easily  for  a time,  as  explained  in  ca- 
tarrhus  calidus.  Class  I.  1.  2.  7.  The  same  circumstance  may 
occur  to  the  inflammation  of  the  membrane,  which  lines  the  up- 
per part  of  the  trachea,  or  it  may  happen  from  the  doubling  of 
the  loosened  upper  part  of  the  adhesive  mucus. 

M.  M.  Frequent  bleeding  by  the  lancet  or  leeches.  A few 
grains  of  calomel.  Seneca.  Blisters  about  the  throat.  An 
opiate  in  small  quantity  at  night  after  previous  evacuations. 
Mercurial  ointment.  Warm  bath.  Breathing  over  the  steam 
of  warm  water,  with  or  without  volatile  alkali,  or  ether,  or  vine- 
gar. Particular  attention  should  be  used  to  keep  the  child  raised 
high  in  bed.  Might  the  skin  be  kept  agreeably  warm,  and  at 
the  same  time  might  quite  cold  air  be  breathed  through  a tube 
coming  from  without,  through  a broken  window,  or  hole  in  a 
door?  Or  might  the  child  be  carried  out  into  the  cold  air  very 
warmly  clad?  If  a solution  of  sublimate  could  be  safely  used  as 
in  gonorrhoea,  Class  II.  1.5.  1? 

After  evacuation  by  copious  venesection,  might  not  the  fre- 
quent application  of  ether  externally  to  the  throat  be  serviceable? 
And  where  there  occur  intervals  of  easy  respiration,  might  not 
breathing  over  the  dust  of  powdered  Peruvian  bark  prevent  a re- 
turn of  the  thickening  of  the  membrane,  as  described  in  Class  II. 
1.6.7. 

5.  Pleuritis.  Pleurisy.  Inflammation  of  the  pleura,  with 
hard  pulse,  pain  chiefly  of  the  side,  pungent,  particularly  increas- 
ed during  inspiration:  lying  on  either  side  uneasy,  the  cough  very 
painful,  dry  at  the  beginning,  afterwards  moist,  often  bloody. 

One  cause  of  pleurisy  is  probably  a previous  adhesion  of  the 
lungs  to  a part  of  the  pleura,  which  envelopes  them.  This  in 
many  cases  has  been  produced  in  infancy,  by  suffering  children 
to  lie  too  long  on  one  side.  Or  by  placing  them  uniformly  on  one 


112 


DISEASES 


Class  II.  1.  2.  6. 


side  of  a fire  or  window,  to  which  they  will  be  liable  always  to 
bend  themselves. 

When  matter  is  produced  during  peripneumony  or  pleurisy 
in  one  side  of  the  chest,  so  long  as  it  is  a concealed  vomica,  the 
fever  continues,  if  the  disease  be  great,  for  many  weeks,  and  even 
months;  and  requires  occasional  venesection,  till  the  patient  sinks 
under  the  inflammatory  or  sensitive  irritated  fever.  But  if  air 
be  admitted,  by  a part  of  the  abscess  opening  itself  a way  into 
the  air  vessels  of  the  lungs,  a hectic  fever,  with  colliquative 
sweats  or  diarrhoea,  supervenes,  and  frequently  destroys  the  pa- 
tient; or  the  abscess  heals,  the  lungs  adhering  to  the  pleura.  See 
pleurodyne  rheumatica.  Class  IV.  1.  2.  16. 

M.  M.  The  lancet  must  be  used  copiously,  and  repeated  as 
often  as  the  pain  and  difficult  respiration  increase.  A blister  on 
the  pained  part.  Antimonial  preparations.  Diluents.  Cool  air. 
Do  neutral  salts  increase  the  tendency  to  cough?  Pediluvium  or 
semicupium  frequently  repeated. 

6.  Diaphragmitis.  Inflammation  of  the  diaphragm.  Pain 
round  the  lower  ribs  as  if  girt  with  a cord.  Difficult  respira- 
tion performed  only  by  elevating  the  ribs  and  in  an  erect  posture. 
The  corners  of  the  mouth  frequently  retracted  into  a disagreeable 
smile,  called  risus  Sardonicus. 

Those  animals,  which  are  furnished  with  clavicles,  or  collar- 
bones, not  only  use  their  foremost  feet  as  hands,  as  men,  mon- 
keys, cats,  mice,  squirrels,  &c.  but  elevate  their  ribs  in  respira- 
tion as  well  as  depress  the  diaphragm  for  the  purpose  of  enlarg- 
ing the  cavity  of  the  chest.  Hence  an  inflammation  of  the  dia- 
phragm is  sudden  death  to  those  animals,  as  horses  and  dogs, 
whichfcan  only  breathe  by  depressing  the  diaphragm;  and  is,  I 
suppose,  the  cause  of  the  sudden  death  of  borses  that  are  over- 
worked; whereas,  in  the  human  animal,  when  the  diaphragm 
is  inflamed,  so  as  to  render  its  motions  impossible  from  the  pain 
they  occasion,  respiration  can  be  carried  on,  though  in  a less  per- 
fect manner,  by  the  intercostal  muscles  in  the  elevation  of  the 
ribs.  In  pleurisy  the  ribs  are  kept  motionless,  and  the  respira- 
tion is  performed  by  the  diaphragm,  as  may  be  readily  seen  oh 
inspecting  the  naked  chest,  and  which  is  generally  a bad  symp- 
tom; in  the  diaphragmitis  the  ribs  are  alternately  elevated,  and 
depressed,  but  the  lower  part  of  the  belly  is  not  seen  to  move. 

M.  M.  As  in  pleurisy  and  peripneumony.  When  the  pa- 
tient becomes  delirious,  and  smiles  disagreeably  by  intervals,  and 
is  beoome  so  weak,  that  evacuations  by  the  lancet  could  be  used 
no  further,  and  I have  almost  despaired  of  my  patient,  I have 
found  in  two  or  three  instances,  that  about  five  or  six  drops  of 
(inct.  thebaic,  given  an  hour  before  the  evening  exacerbation. 


Oiass  II.  1.  2.  7. 


OF  SENSATION. 


173 


have  had  the  happiest  effect,  and  cured  the  patient  in  this  case, 
as  well  as  in  common  peripneumony;  it  must  he  repeated  two  or 
three  evenings,  see  Class  II.  1.  2.  4.  as  the  exacerbation  of  the 
fever,  and  difficult  respiration,  and  delirium,  generally  increase 
towards  night. 

The  stimulus  of  this  small  quantity  of  opium  on  a patient  pre- 
viously so  much  debilitated,  acts  by  increasing  the  exertion  of 
the  absorbent  vessels,  in  the  same  manner  as  a solution  of  opium, 
or  any  other  stimulant,  put  on  an  inflamed  eye  after  the  vessels 
are  previously  emptied  by  evacuations,  stimulates  the  absorbent 
system,  so  as  to  cause  the  remaining  new  vessels  to  be  imme- 
diately reabsorbed.  Which  same  stimulants  would  have  increas- 
ed the  inflammation,  if  they  had  been  applied  before  the  evacua- 
tions. See  Class  II.  1.2.2.  Sect.  XXXIII.  3.  1.  When  the 
sanguiferous  system  is  full  of  blood,  the  absorbents  cannot  act  so 
powerfully,  as  the  progress  of  their  contents  is  opposed  by  the 
previous  fulness  of  the  blood-vessels;  whence  stimulants  in  that 
case  increase  the  action  of  the  secerning  system  more  than  of  the 
absorbent  one;  but,  after  copious  evacuation,  this  resistance  to 
the  progress  of  the  absorbed  fluids  is  removed;  and  when  stimu- 
lants are  then  applied,  they  increase  the  action  of  the  absorbent 
system  more  than  that  of  the  secerning  one.  Hence  opium  given 
in  the  commencement  of  inflammatory  diseases  destroys  the  pa- 
tient; and  cures  them,  if  given  in  very  small  doses  at  the  end  of 
inflammatory  diseases. 

7.  Carditis.  Inflammation  of  the  heart  is  attended  with  un- 
equal intermitting  pulse,  palpitation,  pain  in  the  middle  of  the 
sternum,  and  constant  vomiting.  It  cannot  certainly  be  distin- 
guished from  peripneumony,  and  is  perhaps  always  combined 
with  it. 

8.  Peritonitis.  Inflammation  of  the  peritonaeum  is  known  by 
pain  all  over  the  abdomen,  which  is  increased  on  erecting  the 
body.  It  has  probably  most  frequently  a rheumatic  origin.  See 
Class  II.  1.  2.  17. 

9.  JWesenteritis.  Inflammation  of  the  mesentery  is  attended 
with  pains  like  cholic,  and  with  curdled  or  chyle-like  stools.  It 
is  a very  frequent  and  dangerous  disease,  as  the  production  of 
matter  more  readily  takes  place  in  it  than  in  any  other  viscus. 
The  consequence  of  which,  after  a hard  labour,  is  probably  the 
puerperal  fever,  and  in  scrofulous  habits  a fatal  purulent  fever, 
or  hopeless  consumption. 

M.  M.  Venesection.  Warm  bath.  Emollient  clysters. 

10.  Gastritis.  In  inflammation  of  the  stomach  the  pulse  is 
generally  soft,  probably  occasioned  by  the  sickness  which  attends 


174 


DISEASES 


Class  II.  1.  2.  li. 


it.  The  pain  and  heat  of  the  stomach  are  increased  by  what- 
ever is  swallowed,  with  immediate  rejection  of  it.  Hiccough. 

This  disease  may  be  occasioned  by  acrid  or  indigestible  mat- 
ters taken  into  the  stomach,  which  may  chemically  or  mechani- 
cally injure  its  interior  coat.  There  is,  however,  a slighter  spe- 
cies of  inflammation  of  this  viscus,  and  perhaps  of  all  others, 
which  is  unattended  by  much  fever;  and  which  is  sometimes  in- 
duced by  drinking  cold  water,  or  eating  cold  insipid  food,  as  raw 
turnips,  when  the  person  has  been  much  heated  and  fatigued  by 
exercise.  For  when  the  sensorial  power  has  been  diminished  by 
great  exertion,  and  the  stomach  has  become  less  irritable  by  hav- 
ing been  previously  stimulated  by  much  heat,  it  sooner  becomes 
quiescent  by  the  application  of  cold.  In  consequence  of  this 
slight  inflammation  of  the  stomach,  an  eruption  of  the  face  fre- 
quently ensues  by  the  sensitive  association  of  this  viscus  with  the 
skin,  which  is  called  a surfeit.  See  Class  IV.  1.  2.  13.  and  II. 
1.4.  6.  and  II.  1.3.  19. 

M.  M.  Venesection.  Warm  bath.  Blister.  Anodyne  clys- 
ters. Almond  soap.  See  Class  II.  1.  3.  17. 

11.  Enteritis.  Inflammation  of  the  bowels  is  often  attended 
with  soft  pulse,  probably  owing  to  the  concomitant  sickness; 
which  prevents  sometimes  the  early  use  of  the  lancet,  to  the  de- 
struction of  the  patient.  At  other  times  it  is  attended  with  strong 
and  full  pulse,  like  other  inflammations  of  internal  membranes. 
Can  the  seat  of  the  disease  being  higher  or  lower  in  the  intes- 
tinal canal,  that  is,  above  or  below  the  valve  of  the  colon,  pro- 
duce this  difference  of  pulse  by  the  greater  sympathy  of  one  pare 
of  the  bowels  with  the  stomach  than  another?  In  enteritis  with 
strong  pulse,  the  pain  is  great  about  the  navel,  with  vomiting, 
and  the  greatest  difficulty  in  procuring  a stool.  In  the  other,  the 
pain  and  fever  are  less,  without  vomiting,  and  with  diarrhoea. 
Whence  it  appears,  that  the  enteritis  with  hard  quick  pulse  dif- 
fers from  ileus,  described  in  Class  I.  3.  1.  6.  only  in  the  existence 
of  fever  in  the  former  and  not  in  the  latter,  the  other  symptoms 
generally  corresponding;  and,  secondly,  that  the  enteritis  with 
softer  quick  pulse,  differs  from  the  cholera  described  in  Class  I. 
3.  1.  5.  only  in  the  existence  of  fever  in  the  former,  and  not  in 
the  latter,  the  other  symptoms  being  in  general  similar.  See 
Class  II.  1.3.20. 

Inflammation  of  the  bowels  sometimes  is  owing  to  extraneous 
indigestible  substances,  as  plum-stones,  especially  of  the  dama- 
sin,  which  has  sharp  ends  Sometimes  to  an  introsusception  of 
one  part  of  the  intestine  into  another,  and  very  frequently  to  a 
strangulated  hernia  or  rupture.  In  respect  to  the  first.  I knew 
an  instance  where  a damasin  stone,  after  a long  period  of  time. 


Giass  II.  1.  2.  12. 


OF  SENSATION. 


176 


found  its  way  out  of  the  body  near  the  groin.  I knew  another 
child,  who  vomited  some  damasin  stones,  which  had  lain  for  near 
twenty  hours,  and  given  great  pain  about  the  navel,  by  the  exhi- 
bition of  an  emetic  given  in  repeated  doses  for  about  an  hour. 
The  swallowing  of  plum  stones  in  large  quantities,  and  even  of 
cherry-stones,  is  annually  fatal  to  many  children.  In  respect  to 
the  introsusception  and  hernia,  see  Ileus,  Class  I.  3.  1.  6. 

M.  M.  Repeated  venesection.  Calomel  from  ten  to  twenty 
grains  given  in  small  pills  as  in  ileus;  these  mea-ns  used  early  in 
the  disease  generally  succeed.  After  these  evacuations  a blister 
contributes  to  stop  the  vomiting.  Warm  bath.  Crude  mercury. 
Aloes  one  grain-pill  every  hour  will  frequently  stay  in  the  sto- 
mach. Glauber’s  salt  -dissolved  in  pepper-mint  water  given  by 
repeated  spoonfuls. 

When  the  patient  is  much  reduced,  opium  in  very  small  doses 
may  be  given,  as  a quarter  of  a grain,  as  recommended  in  pleu- 
risy. If  the  pain  suddenly  ceases,  and  the  patient  continues  to  vo- 
mit up  whatever  is  given  him,  it  is  generally  fatal;  as  it  indicates, 
that  a mortification  of  the  bowel  is  already  formed.  Some  au- 
thors have  advised  to  join  cathartic  medicines  with  an  opiate  in 
inflammation  of  the  bowels,  as  recommended  in  colica  saturnina. 
This  may  succeed  in  slighter  cases,  but  is  a dangerous  practice  in 
general;  since,  if  the  obstruction  be  not  removed  by  the  eva- 
cuation, the  stimulus  of  the  opium  is  liable  to  increase  the  action 
of  the  vessels,  and  produce  mortification  of  the  bowel,  as  I think 
I have  seen  more  than  once.  Mercury  injected  by  the  anus,  or 
water  by  a forcing-pump.  See  Ileus  I.  3.  1.  6. 

12.  Hepatitis.  Inflammation  of  the  liver  is  attended  with 
strong  quick  pulse;  tension  and  pain  of  the  right  side;  often 
pungent  as  in  pleurisy,  oftener  dull.  A pain  is  said  to  affect 
the  clavicle,  and  top  of  the  right  shoulder;  with  difficulty  in  ly- 
ing on  the  left  side;  difficult  respiration;  dry  cough;  vomiting 
hiccough. 

There  is  another  hepatitis  mentioned  by  authors,  in  which  the 
fever,  and  other  symptoms,  are  wanting,  or  are  less  violent;  as 
described  in  Class  II.  1.4.  11.  and  which  is  probably  sometimes 
relieved  by  eruptions  of  the  face;  as  in  those  who  are  habituated 
to  the  intemperate  use  of  fermented  liquors. 

M.  M.  Hepatic  inflammation  is  very  liable  to  terminate  in 
suppuration,  and  the  patient  is  destroyed  by  the  continuance  of 
a fever  with  sizy  blood,  but  without  night  sweats,  or  diarrhoea, 
as  in  other  unopened  abscesses.  Whence  copious  and  repeated 
venesection  is  required  early  in  the  disease,  with  repeated  doses 
of  calomel,  and  cathartics.  Warm  bath.  Towards  the  end  of 
the  disease  small  doses  of  opium  before  the  evening  paroxysms, 


m 


DISEASES 


Class  II.  1.  2.  13. 


and  lastly,  the  Peruvian  bark,  and  chalybeate  wine,  at  first  in 
small  doses,  as  20  drops  twice  a day,  and  afterwards,  if  neces- 
sary, in  larger.  See  Art.  IV.  2.  6. 

Towards  the  end  of  hepatitis,  after  repeated  venesection  and 
catharsis,  an  eruption  sometimes  appears  round  the  lips,  which 
is  generally  a salutary  symptom:  and  the  decoction  of  Peruvian 
bark  given  at  this  time,  in  the  quantity  of  about  two  ounces  every 
six  hours,  removes  the  remaining  inflammatory  tendency,  and 
cures  in  a day  or  two. 

Mrs  C.  a lady  in  the  last  month  of  her  pregnancy,  was  seized 
with  violent  hepatitis,  with  symptoms  both  of  peripneumony  and 
of  pleurisy,  for  it  seldom  happens  in  violent  inflammations,  that 
one  viscus  alone  is  affected;  she  wanted  then  about  a fornight  of 
her  delivery,  and  after  frequent  venesection,  with  gentle  cathar- 
tics, with  fomentation  or  warm  hath,  she  recovered  and  was 
safely  delivered,  and  both  herself  and  child  did  well.  Rheuma- 
tic and  eruptive  fevers  are  more  liable  to  induce  abortion. 

13.  Splenitis.  Inflammation  of  the  spleen  commences  with 
tension,  heat,  and  tumour  of  the  left  side,  and  with  pain,  which 
is  increased  by  pressure.  A case  is  described  in  Cdass  I.  2.  3. 
18.  where  a tumid  spleen,  attended  with  fever,  terminated  in 
scirrhus  of  that  viscus. 

14.  Nephritis.  Inflammation  of  the  kidney  seems  to  be  of  two 
kinds;  each  of  them  attended  with  different  symptoms,  and  dif- 
ferent modes  of  termination.  One  of  them  I suppose  to  be  an 
inflammation  of  the  external  membrane  of  the  kidney,  arising 
from  general  causes  of  inflammation,  and  accompanied  with 
pain  in  the  loins  without  vomiting;  and  the  other  to  consist  in 
an  inflammation  of  the  interior  parts  of  the  kidney,  occasioned 
by  the  stimulus  of  gravel  in  the  pelvis  of  it,  which  is  attended 
with  perpetual  vomiting,  with  pain  along  the  course  of  the  ure- 
ter, and  retraction  of  the  testis  on  that  side,  or  numbness  of  the 
thigh. 

The  former  of  these  kinds  of  nephritis  is  distinguished  from 
lumbago  by  its  situation  being  more  exactly  on  the  region  of  the 
kidney,  and  by  its  not  being  extended  beyond  that  part;  after 
three  or  four  days  I believe  this  inflammation  is  liable  to  change 
place;  and  that  a herpes  or  erysipelas,  called  zona,  or  shingles, 
breaks  out  about  the  loins  in  its  stead:  at  other  times  it  is  cured 
by  a cathartic  with  calomel,  with  or  without  previous  venesection. 

The  other  kind  of  nephritis,  or  inflammation  of  the  interior 
part  of  the  kidney,  generally  arises  from  the  pain  occasioned  by 
the  stimulus  of  a stone  entering  the  ureter  from  the  pelvis  of  the 
kidney;  and  which  ceases  when  the  stone  is  protruded  forwards 
into  the  bladder;  or  when  it  is  returned  into  the  pelvis  of  the 


Cuss  II.  1.  2. 15. 


OP  SENSATION. 


177 


kidney  by  the  retrograde  action  of  the  ureter.  The  kidney  is 
nevertheless  inflamed  more  frequently,  though  in  a less  degree, 
from  other  causes;  especially  from  the  intemperate  ingurgitation 
of  ale,  or  other  fermented  or  spirituous  liquors.  This  less  de- 
gree of  inflammation  is  the  cause  of  gravel,  as  that  before  men- 
tioned is  the  effect  of  it.  The  mucus  secreted  to  lubricate  the 
internal  surface  of  the  uriniferous  tubes  of  the  kidney  becomes 
secreted  in  greater  quantity,  when  these  vessels  are  inflamed;  and, 
as  the  correspondent  absorbent  vessels  act  more  energetically  at 
the  same  time,  the  absorption  of  its  more  fluid  parts  is  more 
powerfully  affected;  on  both  these  accounts  the  mucus  becomes 
both  changed  in  quality  and  more  indurated.  And  in  this  man- 
ner stones  are  produced  on  almost  every  mucous  membrane  of 
the  body;  as  in  the  lungs,  bowels,  and  even  in  the  pericardium, 
as  some  writers  have  affirmed.  See  Class  I.  1.3.  9. 

M.  M.  Veneseetion.  Ten  grains  of  calomel  given  in  small 
pills,  then  infusion  of  senna  with  oil.  Warm  bath.  Then  opium 
a grain  and  a half.  See  Class  I.  1.  S.  9.  for  a further  ac- 
count of  the  method  of  cure. 

15.  Cystitis.  Inflammation  of  the  bladder  is  attended  with 
tumour  and  pain  of  the  lower  part  of  the  belly;  with  difficult 
and  painful  micturition;  and  tenesmus.  It  generally  is  pro- 
duced by  the  existence  of  a large  stone  in  the  bladder,  when  in  a 
great  degree;  or  is  produced  by  common  causes,  when  in  a 
slighter  degree. 

The  stone  in  the  bladder  is  generally  formed  in  the  kidney, 
and  passing  down  the  ureter  into  the  bladder  becomes  there  gra- 
dually increased  in  size;  and  this  most  frequently  by  the  apposi- 
tion of  concentric  spheres,  as  may  be  seen  by  sawing  some  of 
the  harder  calculi  through  the  middle,  and  polishing  one  surface. 
These  new  concretions  superinduced  on  the  nucleus,  which  de- 
scended from  the  kidney,  as  described  in  Class  I.  1.3.  9.  and  in 
the  preceding  article  of  this  genus,  is  not  owing  to  the  micro- 
cosmic  salt,  which  is  often  seen  to  adhere  to  the  sides  of  cham- 
ber-pots, as  this  is  soluble  in  warm  water,  but  to  the  mucus  of 
the  bladder,  as  it  rolls  along  the  internal  surface  of  it.  Now 
when  the  bladder  is  slightly  inflamed,  this  mucus  of  its  internal 
surface  is  secreted  in  greater  quantity,  and  is  more  indurated 
by  the  absorption  of  its  more  liquid  part  at  the  instant  of  secre- 
tion, as  explained  in  Class  I.  1.  3.  9.  and  II.  1.  2.  14.  and 
thus  the  stimulus  and  pain  of  a stone  in  the  bladder  contribute 
to  its  enlargement  by  inflaming  the  interior  coat  of  it. 

M.  M.  Venesection.  Warm  bath.  Diluents.  Anodyne 
clysters.  See  Class  I.  1.  3.  9. 

16.  Hysteritis.  Inflammation  of  the  womb  is  accompanied 

vol.  n.  ia 


178 


DISEASES 


Class  II.  2. 1.  ir. 


ivith  heat,  tension,  tumour,  and  pain  of  the  lower  belly.  The 
os  uteri  painful  to  the  touch.  Vomiting.  This  disease  is  ge- 
nerally produced  by  improper  management  in  the  delivery  of 
pregnant  women.  I knew  an  unfortunate  case,  where  the  pla- 
centa was  left  till  the  next  day;  and  then  an  unskilful  accouch- 
eur introduced  his  hand,  and  forcibly  lore  it  aw'ay;  the  conse- 
quence was  a most  violent  inflammatory  fever,  with  hard  throb- 
bing pulse,  great  pain,  very  sizy  blood,  and  the  death  of  the  pa- 
tient. Some  accoucheurs  have  had  a practice  of  introducing 
their  hand  into  the  uterus  immediately  after  the  birth  of  the 
child,  to  take  away  the  placenta;  which  they  said  was  to  save 
time.  Many  women  I believe  have  been  victims  to  this  unna- 
tural practice. 

Others  have  received  injury,  where  inflammation  has  been 
beginning,  by  the  universal  practice  of  giving  a large  dose  of 
opium  immediately  on  delivery,  without  any  indication  of  its 
propriety;  which,  though  a proper  and  useful  medicine,  where 
tire  patient  is  too  feeble,  when  given  in  a small  dose,  as  10 
drops  of  tincture  of  opium,  or  half  a grain  of  solid  opium,  must 
do  a proportionate  injury,  when  it  is  given  improperly;  and  as 
delivery  is  a natural  process,  it  is  certainly  more  wise  to  give  no 
medicines,  except  there  he  some  morbid  symptom,  which  re- 
quires it;  and  which  has  only  been  introduced  into  custom  by 
the  ill-employed  activity  of  the  priests  or  priestesses  of  Lucina; 
like  the  concomitant  nonsense  of  cramming  rue  or  rhubarb  into 
the  mouth  of  the  unfortunate  young  stranger,  who  is  thus  soon 
made  to  experience  the  evils  of  life.  See  Class  II.  1.  1.  12. 
and  I.  1.2.  5.  Just  so  some  over-wise  beldames  force  young 
ducks  and  turkeys,  as  soon  as  they  are  hatched,  to  swallow  a 
pepper  corn. 

M.  M.  Venesection  repeatedly;  diluents;  fomentation;  the 
patient  should  be  frequently  raised  up  in  bed  for  a short  time, 
to  give  opportunity  of  discharge  to  the  putrid  lochia;  mucila- 
ginous clysters.  See  Febris  Puerpera. 

17.  Lumbago  sensiiiva  Sensitive  lumbago.  "When  the  exten- 
sive membranes,  or  ligaments,  which  cover  the  muscles  of  the 
hack  are  torpid,  as  in  the  cold  paroxysm  of  ague,  they  are  attend- 
ed with  pain  in  consequence  of  the  inaction  of  the  vessels  which 
compose  them.  When  this  inaction  continues  without  a conse- 
quent renewal  or  increase  of  activity,  the  disease  becomes  chroni- 
cal, and  forms  the  lumbago  frigida,  or  irritativa,  described  in 
Class  I.  2.  4.  16.  But  when  this  cold  tit  or  torpor  of  these 
membranes,  or  ligaments  or  muscles  of  the  back,  is  succeeded  by 
a hot  fit,  and  consequent  inflammation,  a violent  inflammatory 
fever,  with  great  pain,  occurs,  preventing  the  erect  posture  o' 


Class  II.  1.  2.  18. 


OF  SENSATION. 


179 


the  body,  and  the  affected  part  is  liable  to  suppurate,  in  which 
case  a very  dangerous  ulcer  is  formed,  and  a part  of  one  of  the 
vertebras  is  generally  found  carious,  and  the  patient  sinks  after  a 
long  time  under  the  hectic  fever  occasioned  by  the  aerated  or 
oxygenated  matter. 

This  disease  bears  no  greater  analogy  to  rheumatism  than  the 
inflammation  of  the  pleura,  or  any  other  membranous  inflam- 
mation; and  has  therefore  unjustly  been  arranged  under  that 
name.  It  is  distinguished  from  nephritis,  as  it  is  seldom  attend- 
ed with  vomiting,  I suppose  never,  except  the  ureter  happens  to 
be  inflamed  at  the  same  time. 

The  pain  sometimes  extends  on  the  outside  of  the  thigh 
from  the  hip  to  the  ankle,  heel,  or  toes,  and  is  then  called 
sciatica;  and  has  been  thought  to  consist  in  an  inflammation  of 
the  theca,  or  covering  of  the  sciatic  nerve,  as  the  pain  some- 
times so  exactly  attends  the  principal  branches  of  that  nerve.  See 
Class  I.  2.  4.  15.  16. 

M.  M.  Venesection  repeatedly;  calomel;  gentle  cathartics; 
diluents;  warm  bath;  poultice  on  the  back,  consisting  of  camo- 
mile flowers,  turpentine,  soap,  and  opium;  a Burgundy  pitch 
plaster.  A debility  of  the  inferior  limbs  from  the  torpor  of  the 
muscles,  which  had  previously  been  too  much  excited,  frequent- 
ly occurs  at  the  end  of  this  disease;  in  this  case  electricity,  and 
issues  on  each  side  of  the  lumbar  vertebras,  are  recommended. 
See  Class  I.  2.  4.  16. 

18.  Ischias.  The  ischias  consists  of  inflammatory  fever,  with 
great  pain  about  the  pelvis,  the  os  coccygis,  and  the  heads  of  the 
thigh-bones,  preventing  the  patient  from  walking  or  standing 
erect,  with  increase  of  pain  on  going  to  stool.  This  malady,  as 
•well  as  the  preceding,  has  been  ascribed  to  rheumatism;  with 
which  it  seems  to  bear  no  greater  analogy,  than  the  inflamma- 
tions of  any  other  membranes. 

The  patients  are  left  feeble,  and  sometimes  lame  after  this 
disease;  which  is  also  sometimes  accompanied  with  great  flow 
of  urine,  owing  to  the  defective  absorption  of  its  aqueous  parts; 
and  with  consequent  thirst  occasioned  by  the  want  of  so  much 
fluid  being  returned  into  the  circulation;  a lodgment  of  fasces 
in  the  rectum  sometimes  occurs  after  this  complaint  from  the 
lessened  sensibility  of  it.  See  Class  I.  2.  4.  15. 

M.  M.  Venesection;  gentle  cathartics;  diluents;  fomenta- 
tion; poultice  with  camomile  flowers,  turpentine,  soap,  and 
opium;  afterwards  the  bark.  See  Class  I.  1.3.  5. 

When  this  inflammation  terminates  in  suppuration  the  matter 
generally  can  be  felt  to  fluctuate  in  the  groin,  or  near  the  top  of 
the  thigh.  In  this  circumstance,  my  friend,  Mr.  Bent,  surgeon. 


180 


DISEASES 


Class  II.  1.  2.  19. 


near  Newcastle  in  Staffordshire,  proposes  to  tap  the  abscess  by 
means  of  a trocar,  and  thus  as  often  as  necessary  to  discharge  the 
matter  without  admitting  the  air.  Might  a weak  injection  of 
wine  and  water,  as  in  the  hydrocele,  be  used  with  great  caution 
to  inflame  the  walls  of  the  abscess,  and  cause  them  to  unite? 
See  Class  II.  1.  6.  9. 

1 9.  Paronychia  interna.  Inflammation  beneath  the  finger-nail. 
The  pain  occasioned  by  the  inflammatory  action  and  tumour  of 
parts  bound  down  between  the  nail  on  one  side  and  the  bone  on 
the  other,  neither  of  which  will  yield,  is  said  to  occasion  so  much 
pain  as  to  produce  immediate  delirium,  and  even  death,  except 
the  parts  are  divided  by  a deep  incision;  which  must  pass  quite 
through  the  periosteum,  as  the  inflammation  is  said  generally  to 
exist  beneath  it.  This  disease  is  thus  resembled  by  the  process 
of  toothing  in  young  children;  where  an  extraneous  body  lodged 
beneath  the  periosteum  induces  pain  and  fever,  and  sometimes 
delirium,  and  requires  to  be  set  at  liberty  by  the  lancet. 


Class  II.  1.  3. 


OF  SENSATION. 


181 


ORDO  I. 

Increased  Sensation. 

GENUS  III. 

With  the  Production  of  new  Vessels  by  external  Membranes  or 
Glands , with  Fever.  . 

The  diseases  of  this  genus  are  perhaps  all  productive  of  con- 
tagious matter;  or  which  becomes  so  by  its  exposure  to  the  air, 
either  through  the  cuticle,  or  by  immediate  contact  with  it; 
such  are  the  matters  of  the  small-pox  and  measles.  The  puru- 
lent matter  formed  on  parts  covered  from  the  air  by  thicker 
membranes  or  muscles,  as  in  the  preceding  genus,  does  not  in- 
duce fever;  and  cannot  therefore  be  called  contagious;  but  it 
acquires  this  property  of  producing  fever  in  a few  hours,  after 
the  abscess  has  been  opened,  so  as  to  admit  the  air  to  its  surface, 
and  may  then  be  said  to  consist  of  contagious  miasmata.  This 
kind  of  contagious  matter  only  induces  fever,  but  does  not  pro- 
duce other  matter  with  properties  similar  to  its  own;  and  in 
this  respect  it  differs  from  the  contagious  miasmata  of  small-pox 
or  measles,  but  resembles  those  which  have  their  origin  in  crowd- 
ed jails;  for  these  produce  fever  only,  which  frequently  de- 
stroys the  patient;  but  do  not  produce  other  matters  similar  to 
themselves;  as  appears  from  none  of  those  who  died  of  the  jail- 
fever,  caught  at  the  famous  black  assizes  at  Oxford,  at  the  be- 
ginning of  this  century,  having  infected  their  physicians  or  at- 
tendants. 

If  indeed  the  matter  has  continued  so  long  as  to  become  putrid, 
and  thus  to  have  given  out  air  from  a part  of  it,  it  acquires  the 
power  of  producing  fever;  in  the  same  manner  as  if  the  ulcer 
had  been  opened,  and  exposed  to  the  common  air;  instances  of 
which  are  not  unfrequent.  And  from  these  circumstances  it 
seems  probable,  that  the  matters  secreted  by  the  new  vessels 
formed  in  all  kinds  of  phlegmons,  or  pustules,  are  not  conta- 
gious, till  they  have  acquired  something  from  the  atmosphere,  or 
from  the  gas  produced  by  putrefaction;  which  will  account  for 
some  phenomena  in  the  lues  venerea,  cancer,  and  of  other  con- 
tagious secretions  on  the  skin  without  fever,  to  be  mentioned 
hereafter.  See  Class  II.  1.  4.  14. 

The  theory  of  contagion  has  been  perplexed  by  comparing  it 
with  fermenting  liquors;  but  the  contagious  material  is  shewn 
in  Section  XXXIII.  to  be  produced  like  other  secreted  matters, 


182 


DISEASES 


Class  II.  1.  3. 

by  certain  animal  motions  of  the  terminations  of  the  vessels. 
Hence  a new  kind  of  gland  is  formed  at  the  terminations  of  the 
vessels  in  the  eruptions  of  the  small -pox;  the  animal  motions  of 
which  produce  from  the  blood  variolous  matter;  as  other  glands 
produce  bile  or  saliva.  Now  if  some  of  this  matter  is  introduced 
beneath  the  cuticle  of  a heahhy  person,  or  enters  the  circulation, 
and  excites  the  extremities  of  the  blood-vessels  into  those  kinds 
of  diseased  motions,  by  which  it  was  itself  produced,  either  by 
irritation  or  association,  these  diseased  motions  of  the  extremities 
of  the  vessels  will  produce  other  similar  contagious  matter.  See 
Sect.  XXXIII.  2.  5.  and  9.  Hence  contagion  seems  to  be  pro- 
pagated two  ways;  .one,  by  the  stimulus  of  contagious  matter  ap- 
plied to  the  part,  which  by  an  unknown  law  of  nature  excites 
the  stimulated  vessels  to  produce  a similar  matter;  as  in  vene- 
real ulcers,  which  thus  continue  to  spread;  or  as  when  variolous 
matter  is  inserted  beneath  the  cuticle;  or  when  it  is  supposed  to 
be  absorbed,  and  diffused  over  the  body  mixed  with  the  blood, 
and  applied  in  that  manner  to  the  cutaneous  glands.  The  other 
•way,  by  which  contagion  seems  to  be  diffused,  is  by  some  dis- 
tant parts  sympathizing  or  imitating  the  motions  of  the  part  first 
affected;  as  the  stomach  and  skin  in  the  eruptions  of  the  inocu- 
lated small-pox,  or  in  the  bite  of  a mad  dog;  as  treated  of  in 
Sect.  XXII.  3.  3. 

In  some  of  the  diseases  of  this  genus,  the  pulse  is  strong,  full, 
and  hard,  constituting  the  sensitive  irritated  fever,  as  described 
in  the  preceding  genus;  as  in  one  kind  of  erysipelas,  which  re- 
quires repeated  venesection.  In  others  the  arterial  action  is 
sometimes  moderate,  so  as  to  constitute  the  sensitive  fever,  as  in 
the  inoculated  small-pox;  where  the  action  of  the  arteries  is 
neither  increased  by  the  sensorial  power  of  irritation,  as  in  the 
sensitive  irritated  fever;  nor  decreased  by  the  defect  of  that  power, 
as  in  the  sensitive  inirritated  fever.  But  in  the  greatest  number 
of  the  diseases  of  this  genus  the  arterial  action  is  greatly  diminish- 
ed in  respect  to  strength,  and  consequently  the  frequency  cf  pul- 
sation is  proportionally  increased,  as  explained  in  Sect.  XXXII. 
2.  1.  Which  is  owing  to  the  deficiency  of  the  sensorial  power 
of  irritation  joined  with  the  increase  of  that  of  sensation,  aud  thus 
constitutes  the  sensitive  inirritated  fever;  as  in  scarlatina  with 
gangrenous  tonsils. 

From  this  great  debility  of  the  action  of  the  arteries,  there 
appears  to  be  less  of  the  coagulable  lymph  or  mucus  secreted  on 
their  internal  surfaces;  whence  there  is  not  only  a defect  of 
that  buff  or  size  upon  the  blood,  which  is  seen  on  the  surface  of 
that  which  is  drawn  in  the  sensitive  irritated  fever;  but  the 
blood,  as  it  cools,  when  it  has  been  drawn  into  a basin,  scarcely 


Class  II.  1.  3. 


OF  SENSATION. 


183 


coagulates;  and  is  said  to  be  dissolved,  and  is  by  some  supposed 
to  be  in  a state  of  actual  putrefaction.  See  Sect.  XXX11I.  1. 
3.  where  the  truth  of  this  idea  is  controverted.  But  in  the  fevers 
of  both  this  genus  and  the  preceding  one,  great  heat  is  produced 
from  the  chemical  combinations  in  the  secretions  of  new  vessels 
and  fluids,  and  pain  or  uneasiness  from  the  distention  of  the  old 
ones;  till  towards  the  termination  of  the  disease  sensation  ceases, 
as  well  as  irritation,  with  the  mortification  of  the  affected  parts, 
and  the  death  of  the  patient. 

Dysenteria,  as  well  as  tonsillitis  and  aphtha,  are  enumerated 
amongst  the  diseases  of  external  membranes,  because  they  are 
exposed  either  to  the  atmospheric  air  which  is  breathed  and 
swallowed  with  our  food  and  saliva;  or  they  are  exposed  to  the 
inflammable  air,  or  hydrogen,  which  is  generated  in  the  iutes- 
tines;  both  which  contribute  to  produce  or  promote  the  conta- 
gious quality  of  these  fluids;  as  mentioned  in  Class  II.  1.  6. 

It  is  not  speaking  accurate  language,  if  we  say,  that,  in  the 
diseases  of  this  genus,  the  fever  is  contagious;  since  it  is  the  ma- 
terial produced  by  the  external  membranes  which  is  contagious, 
after  it  has  been  exposed  to  air;  while  the  fever  is  the  conse- 
quence of  this  contagious  maitter,  and  not  the  cause  of  it.  As  ap- 
pears from  the  inoculated  small-pox,  in  which  the  fever  does  not 
commence,  till  after  suppuration  has  taken  place  in  the  inoculat- 
ed arm,  and  from  the  diseases  of  the  fifth  genus  of  this  order, 
where  contagion  exists  without  fever.  See  Class  II.  1.  5.  and 
II.  1.3.  18. 

The  existence  of  contagious  miasmata  in  the  atmosphere  was 
believed  even  in  the  time  of  Homer,  and  was  allegorized  under 
the  title  of  the  arrows  of  Apollo.  Seecatarrhus  contagiosus,  II. 
I.  3.  6.  Of  these  it  is  probable,  that  some  contagious  matters 
are  only  diffused  in  the  atmosphere,  as  that  of  the  small-pox,  as  it 
seems  only  to  infect  those  who  are  very  near  the  variolous  pa- 
tient; and  seems  to  be  swallowed  with  the  saliva,  and  thence  to 
affect  tlie  tonsils.  Other  contagions  may  be  dissolved  in  the  at- 
mosphere, as  that  of  the  measles,  and  of  epidemic  catarrhs,  which 
therefore  first  affect  the  membranes  of  the  nostrils  in  men,  and  of 
the  maxillary  sinuses  also  in  dogs  and  horses. 

Contagious  materials  have  been  also  believed  from  remote  an- 
tiquity to  lodge  in  the  walls  of  rooms  where  the  sick  have  been 
confined;  as  in  the  wards  of  hospitals,  jails,  ships,  as  well  as  in 
the  bedding  or  clothes  of  the  infected.  The  methods  of  purifying 
infected  houses  seem  also  to  have  been  studied  in  the  remotest 
times;  the  Levitical  law  directs  the  walls  of  the  house  of  a leprous 
person  to  be  scraped;  and  in  modern  times  white- washings  with 


184 


DISEASES 


Class  11.  1.  3. 


lime  and  painting  with  oil  have  been  directed,  I believe,  with 
great  success. 

Mr.  Cruikshank  has  lately  recommended  two  or  three  parts 
of  sulphur  with  one  of  nitre  to  be  mixed  together,  and  set  in  a 
room  close  shut  up,  and  ignited  by  dropping  a lighted  coal  upon 
it;  as  the  nitre  will  supply  sufficient  oxygen  to  inflame  the  sul- 
phur in  a close  apartment,  and  thus  to  fill  the  whole  with  the 
sulphurous  vapour;  so  as  to  pass  into  every  minute  aperture  of 
the  walls  or  furniture. 

Another  means  of  sweetening  the  air  of  hospitals,  where  many 
ulcerous  patients  are  crowded  together,  has  been  also  recom- 
mended, and  might  perhaps  be  used  with  salutary  effect  to  restore 
the  air  of  play-houses,  churches,  close  parlours,  courts  of  law,  and 
other  places,  where  many  people  resort  without  due  ventilation, 
which  consists  in  well  mixing  four  ounces  of  common  salt  with 
two  ounces  of  pulverized  manganese  in  a basin;  to  these  are  then 
to  be  added  about  two  ounces  of  water,  and  afterwards  three 
ounces  of  concentrated  sulphuric  acid,  in  small  portions  at  a 
time;  and  wdien  managed  in  this  way,  the  gas  is  said  not  to  be 
in  the  least  offensive  itself,  and  at  the  same  time  destroys  disa- 
greeable smells,  and  perhaps  also  infectious  miasmata.  Medical 
'Review,  No.  3 2. 

The  wdirte  vapours,  not  the  red  ones,  of  nitrous  acid  have  been 
employed  with  wonderful  success,  by  Dr.  C.  Smyth,  in  the  hos- 
pital ships,  without  removing  the  patients;  some  sand  is  made 
hot  in  crucibles,  many  of  which  arc  brought  into  the  rooms  to  be 
fumigated;  in  this  hot  sand  is  then  set  a tea-cup  containing  about 
half  an  ounce  of  concentrated  vitriolic  acid,  to  which,  after  it  had 
acquired  a proper  heat,  an  equal  quantity  of  nitre  in  powder  is 
gradually  added,  and  the  mixture  stirred  with  a glass  spatula,  till 
the  vapour  arises  from  it  in  considerable  quantity.  The  crucible 
or  pipkin  is  then  carried  about  the  wards  by  the  nurses  or  con- 
valescents, who  walk  about  with  them,  like  incense-pots,  in  their 
hands,  and  by  thus  fumigating  the  ship  morning  and  night,  with 
the  care  of  washing  the  beds  and  clothes,  and  exposing  them  to 
the  air,  the  contagion  appeared  to  be  quickly  slopped,  and  the 
patients  already  affected  soon  recovered. 

If  any  metallic  vessel  be  used,  the  white  nitrous  vapour  be- 
comes red,  and  what  was  salutary  before  becomes  now  noxious, 
as  is  observed  bv  Mr.  Keir,  in  his  letter  on  this  subject,  who 
adds,  that  though  much  vital  air  is  extricated  from  the  mixture, 
he  rather  ascribes  its  good  effect  to  the  known  property  of  all 
mineral  acids  in  stopping  the  processes  of  fomentation  and  pu- 
trefaction; as  (he  contagious  miasmata  are  presumed  to  consist 


Class  II.  1.  3.  1.  OF  SENSATION.  18;5 

of  animal  matter  in  some  vicious  kind  of  fermentation.  Medi- 
cal Review,  Vol.  III.  p.  17. 

SPECIES. 

1 . Fe.br is  sensitiva  inirritata.  Sensitive  inirritated  fever.  Ty- 
phus gravior.  Putrid  malignant  fever.  Jail  fever.  The  imme- 
diate cause  of  this  disease  is  the  increase  of  the  sensorial  power 
of  sensation,  joined  with  the  decrease  of  the  sensorial  power  of 
irritation;  that  is,  it  consists  in  the  febris  sensitiva  joined  with  the 
febris  inirritativa  of  Class  I.  2.  1.  1.  as  the  febris  sensitiva  irri- 
tata  of  the  preceding  genus  consists  of  the  febris  sensitiva  joined 
with  the  febris  irritativa  of  Class  I.  1 . 1 . 1 . In  both  which  the 
words  irritata  and  inirritata,  are  designed  to  express  more  or  less 
irritation  than  the  natural  quantity;  and  the  same  when  applied 
to  some  of  the  diseases  of  this  genus. 

This  fever  is  frequently  accompanied  with  topical  inflamma- 
tion, which  is  liable,  if  the  arterial  strength  is  not  supported,  to 
end  in  sphacelus;  and  as  mortified  parts,  such  as  sloughs  of  the 
throat,  if  they  adhere  to  living  parts,  soon  become  putrid  from 
the  warmth  and  moisture  of  their  situation;  these  fevers  have 
been  termed  putrid,  and  have  been  thought  to  owe  their  cause  to 
what  is  only  their  consequence.  In  hot  climates  this  fever  is 
frequently  induced  by  the  exhalations  of  stagnating  lakes  or 
marshes,  which  abound  with  animal  substances;  but  which  in 
colder  countries  produce  fevers  with  debility  only,  as  the  quar- 
tan ague,  without  inflammation. 

The  sensitive  inirritated,  or  malignant  fever,  is  also  frequently 
produced  by  the  putrid  exhalations  and  stagnant  air  in  prisons; 
but  perhaps  most  frequently  by  contact  or  near  approach  of  the 
persons  who  have  resided  in  them.  These  causes  of  malignant 
fevers  contributed  to  produce,  and  to  support  for  a while,  the 
septic  and  antiseptic  theory  of  them;  see  Sect.  XXXIII.  1.  3. 
The  vibices  or  bruises,  and  petechiae  or  purples,  were  believed 
to  be  owing  to  the  dissolved  state  of  the  blood  by  its  incipient 
putrefaction;  but  hydrostatical  experiments  have  been  made, 
which  shew  the  sizy  blood  of  the  patient  in  sensitive  irritated  or 
inflammatory  fever,  with  strong  pulse,  is  more  fluid,  while  it  is 
warm,  than  this  uncoagulable  blood  taken  in  this  sensitive  inirri- 
tated, or  malignant  fever;  from  whence  it  is  inferred,  that  these 
petechiae,  and  vibices,  are  owing  to  the  deficient  power  of  absorp- 
tion in  the  terminations  of  the  veins.  See  Class  I.  2.  1.  5. 

This  sensitive  inirritated  fever,  or  typhus  gravior,  is  distin- 
guished from  the  inirritative  fever,  or  typhus  mitior,  in  the  ear- 
ly stages  of  it,  by  the  colour  of  the  skin;  which  in  the  latter  te 

VOL.  II.  b b 


186 


DISEASES 


Class  II.  1.  3.  1. 


paler,  with  less  heat,  owing  to  the  less  violent  action  of  the  ca- 
pillaries; in  this  it  is  higher  coloured,  and  hotter,  from  the  greater 
energy  of  the  capillary  action  in  the  production  of  new  vessels. 
In  the  more  advanced  state  petechias,  and  the  production  of  con- 
tagious matter  from  inflamed  membranes,  as  the  aphthae  of  the 
mouth,  or  ulcers  of  the  throat,  distinguish  this  fever  from  the 
former.  Delirium,  and  dilated  pupils  of  the  eyes,  are  more  fre- 
quent in  nervous  fevers;  and  stupor  with  deafness  a more  fre- 
quent attendant  on  malignant  fevers.  See  Class  I.  2.  5.  6. 

There  is  another  criterion  discernible  by  the  touch  of  an  ex- 
perienced finger;  and  that  is,  the  coat  of  the  artery  in  inflamma- 
tory fevers,  both  those  attended  with  strength  of  pulsation,  and 
these  with  weak  pulsation,  feels  harder,  or  more  like  a cord;  for 
the  coats  of  the  arteries  in  these  fevers  are  themselves  inflamed, 
and  are  consequently  turgid  with  blood,  and  thence  are  less  easily 
compressed,  though  their  pulsations  are  nevertheless  weak:  when 
the  artery  is  large  or  full  with  an  inflamed  coat,  it  is  hard;  and 
when  small  or  empty  with  an  inflamed  coat,  it  is  called  sharp, 
by  many  writers. 

M.  M.  The  indications  of  cure  consist,  1.  In  procuring  a 
Regurgitation  of  any  offensive  material,  which  may  be  lodged  in 
the  long  mouths  of  the  lacteals  or  lymphatics,  or  in  their  tumid 
glands.  2.  To  excite  the  system  into  necessary  action  by  the 
repeated  exhibition  of  nutrientia,  sorbentia,  and  iucitantia;  and 
to  preserve  the  due  evacuation  of  the  bowels.  3.  To  prevent 
any  unnecessary  expenditure  of  sensorial  power.  4.  To  prevent 
the  formation  of  ulcers,  or  to  promote  the  absorption  in  them, 
for  the  purpose  of  healing  them. 

1.  One  ounce  of  wine  of  ipecacuanha,  or  about  ten  grains  of 
the  powder,  should  be  given  as  an  emetic.  After  a few  hours 
three  or  four  grains  of  calomel  should  be  given  in  a little  muci- 
lage, or  conserve.  Where  something  swallowed  into  the  stomach 
is  the  cause  of  the  fever,  it  is  liable  to  be  arrested  by  the  lympha- 
tic glands,  as  the  matter  of  the  small-pox  inoculated  in  the  arm 
is  liable  to  be  stopped  by  the  axillary  lymphatic  gland;  in  this 
situation  it  may  continue  a day  or  tw’o,  or  longer,  and  may  be 
regurgitated  during  the  operation  of  an  emetic  or  cathartic  into 
the  stomach  or  bowel,  as  evidently  happens  on  the  exhibition  of 
calomel,  as  explained  in  Sect.  XXIX.  7.  2.  For  this  reason 
an  emetic  and  cathartic,  with  venesection,  if  indicated  by  the 
hardness  and  fulness  of  the  pulse,  will  very  frequently  remove 
fevers,  if  exhibited  on  the  first,  second,  or  even  third  day. 

2.  Wine  and  opium,  in  small  doses  repeated  frequently,  but 
so  that  not  the  least  degree  of  intoxication  follows,  for  in  that 
case  a greater  degree  of  debility  is  produced  from  the  expendi- 


Class  II.  1.  3.  1. 


OF  SENSATION. 


187 


ture  of  sensorial  power  in  unnecessary  motions.  Many  weak 
patients  have  been  thus  stimulated  to  death.  See  Sect.  XII.  7. 
8.  The  Peruvian  bark  should  be  given  also  in  repeated  doses, 
in  such  quantity  only  as  may  strengthen  digestion,  not  impede 
it.  For  these  purposes  two  ounces  of  wine,  or  of  ale,  or  cyder, 
should  be  given  every  six  hours;  and  two  ounces  of  decoction 
of  bark,  with  two  drachms  of  the  tincture  of  bark,  and  six  drops 
of  tincture  of  opium,  should  be  given  also  every  six  hours  alter- 
nately; that  is,  each  of  them  four  times  in  twenty-four  hours. 
As  much  rhubarb  as  may  induce  a daily  evacuation,  should  be 
given  to  remove  the  colluvies  of  indigested  materials  from  the 
bowels;  which  might  otherwise  increase  the  distress  of  the  pa- 
tient by  the  air  it  gives  out  in  putrefaction,  or  by  producing 
a diarrhoea  by  its  acrimony;  the  putridity  of  the  evacuations  is 
owing  to  the  total  inability  of  the  digestive  powers;  and  their 
delay  in  the  intestines,  to  the  inactivity  of  that  canal  in  respect 
to  its  peristaltic  motions. 

The  quantities  of  wine  or  beer  and  opium,  and  bark,  above 
mentioned  may  be  increased  by  degrees,  if  the  patient  seems 
refreshed  by  them;  and  if  the  pulse  becomes  slower  on  their 
exhibition;  but  this  with  caution,  as  I have  seen  irrecoverable 
mischief  done  by  greater  quantities  both  of  opium,  wine,  and 
bark,  in  this  kind  of  fever;  in  which  their  use  is  to  strengthen 
the  digestion  of  the  weak  patient,  rather  than  to  stop  the  pa- 
roxysms of  fever;  but  when  they  are  administered  in  intermit- 
tents,  much  larger  quantities  are  necessary. 

The  stimulus  of  small  blisters  applied  in  succession,  one  every 
three  or  four  days,  when  the  patient  becomes  weak,  is  of  great 
service  by  strengthening  digestion,  and  by  preventing  the  cold- 
ness of  the  extremities,  owing  to  the  sympathy  of  the  skin  with 
the  stomach,  and  of  one  part  of  the  skin  with  another. 

In  respect  to  nutriment,  the  patient  should  be  supplied  with 
wine  and  water,  with  toasted  bread,  and  sugar  or  spice  in  it;  or 
with  sago  with  wine;  fresh  broth  with  turnips,  celery,  parsley, 
fruit;  new  milk.  Tea  with  cream  and  sugar;  bread  pudding, 
with  lemon-juice  and  sugar;  chicken,  fish,  or  whatever  is  grate- 
ful to  the  palate  of  the  sick  person,  in  small  quantity  repeated  fre- 
quently; with  small  beer,  cyder  and  water,  or  wine  and  water, 
for  drink,  which  may  be  acidulated  with  acid  of  vitriol  in  small 
quantities. 

3.  All  unnecessary  motions  are  to  be  checked,  or  prevented. 
Hence  horizontal  posture,  obscure  room,  silence,  cool  air.  All 
the  parts  of  the  skin,  which  feel  too  hot  to  the  hand,  should  be 
exposed  to  a current  of  cool  air,  or  bathed  with  cold  water, 
whether  there  are  eruptions  on  it  or  not,  Wash  the  patient 


188 


DISEASES 


Class  II.  1.  3.  2. 


twice  a day  with  cold  vinegar  and  water,  or  cold  salt  and  water, 
or  cold  water  alone  by  means  of  a sponge.  If  some  parts  are 
too  cold,  as  the  extremities,  while  other  parts  are  too  hot,  as  the 
face  or  breast,  cover  the  cold  parts  with  flannel,  and  cool  the  hot 
parts  by  a current  of  cool  air,  or  bathing  them  as  above. 

4.  For  the  healing  of  ulcers,  if  in  the  mouth,  solution  of  alum 
in  water  about  40  grains  to  an  ounce,  or  of  blue  vitriol  in  water, 
one  grain  or  two  to  an  ounce,  may  be  used  to  touch  them  with 
three  or  four  times  a day.  Of  these  perhaps  a solution  of  alum 
is  to  be  preferred,  as  it  instantly  takes  away  the  stench  from 
ulcers,  I suppose  by  combining  with  the  volatile  alkali  which  at- 
tends it.  For  this  purpose  a solution  of  alum  of  an  ounce  to  a pint 
of  water  should  be  frequently  injected  by  means  of  a syringe  into 
the  mouth.  If  there  are  ulcers  on  the  external  skin,  fine  powder 
of  bark  seven  parts,  and  cerussa  in  fine  powder  one  part,  should 
be  mixed  and  applied  dry  on  the  sore,  and  kept  on  by  lint  and  a 
bandage. 

As  sloughs  in  the  mouth  are  frequently  produced  by  the  previ- 
ous dryness  of  the  membranes  which  line  it,  this  dryness  should 
be  prevented  by  frequently  moistening  them,  which  may  be  af- 
fected by  injection  with  a syringe,  or  by  a moist  sponge,  or  last- 
ly in  the  following  manner.  Place  a glass  of  wine  and  water,  or 
of  milk  and  sugar,  on  a table  by  the  bed  side,  a little  above  the 
level  of  the  mouth  of  the  patient;  then,  having  previously  mois- 
tened a long  piece  of  narrow  listing,  or  cloth,  or  flannel,  with  the 
same  liquor,  leave  one  end  of  it  in  the  glass,  and  introduce  the 
other  into  the  mouth  of  the  patient;  which  will  thus  be  supplied 
with  a constant  oozing  of  the  fluid  through  the  cloth,  w hich  acts 
as  a capillary  syphon. 

The  viscid  phlegm,  which  adheres  to  the  tongue,  should  be  coa- 
gulated by  some  austere  acid,  as  by  lemon-juice  evaporated  to 
half  its  quantity,  or  by  crab-juice;  and  then  it  may  be  scraped 
off  by  a knife,  or  rubbed  off  by  flannel,  or  a sage-leaf  dipped  in 
vinegar,  or  in  salt  and  wrater. 

2.  Erysipelas.  St.  Anthony’s  fire  may  be  divided  into  three 
kinds,  which  differ  in  their  method  of  cure,  the  irritated,  the  in- 
irritated,  and  the  sensitive  erysipelas. 

Erysipelas  irritatum  is  attended  with  increase  of  irritation  be- 
sides increase  of  sensation;  that  is,  with  strong,  hard  and  full 
pulse,  which  requires  frequent  venesection,  like  other  inflamma- 
tions with  arterial  strength.  It  is  distinguished  from  the  phleg- 
monic inflammations  of  the  last  genus  by  its  situation  on  the 
external  habit,  and  by  the  redness,  heat,  and  tumour,  not  being 
distinctly  circumscribed;  so  that  the  eye  or  finger  cannot  exactly 
tyace  the  extent  of  them. 


Class  II.  1.  3.  2. 


OF  SENSATION. 


189 


When  the  external  skin  is  the  seat  of  inflammation,  and  pro- 
duces sensitive  irritated  fever,  no  collection  of  matter  is  formed, 
as  when  a phlegmon  is  situated  in  the  cellular  membrane  beneath 
the  skin;  but  the  cuticle  rises  as  beneath  a blister-plaster,  and 
becomes  ruptured;  and  a yellow  material  oozes  out,  and  be- 
comes inspissated,  and  lies  upon  its  surface;  as  is  seen  in  this 
kind  of  erysipelas,  and  in  the  confluent  small-pox;  or  if  the  new 
vessels  are  re-absorbed  the  cuticie  peels  off  in  scales.  This  dif- 
ference of  the  termination  of  erysipelatous  and  phlegmonic  inflam- 
mation seems  to  be  owing  in  part  to  the  less  distensibility  of  the 
cuticle  than  of  the  cellular  membrane,  and  in  part  to  the  ready 
exhalation  of  the  thinner  parts  of  the  secreted  fluids  through  its 
pores. 

This  erysipelas  is  generally  preceded  by  a fever  for  two  or 
three  days  before  the  eruption,  which  is  liable  to  appear  in  some 
places  as  it  declines  in  others;  and  seems  frequently  to  arise 
from  a previous  scratch  or  injury  of  the  skin;  and  is  attended 
sometimes  with  inflammation  of  the  cellular  membrane  beneath 
the  skin;  whence  a real  phlegmon  and  collection  of  matter  be- 
come joined  to  the  erysipelas,  and  either  occasion  or  increase 
the  irritated  fever,  which  attends  it. 

There  is  a greater  sympathy  between  the  external  skin  and 
the  meninges  of  the  brain,  than  between  the  cellular  membrane 
and  those  meninges;  whence  erysipelas  is  more  liable  to  be  pre- 
ceded, or  attended,  or  succeeded,  by  delirium  than  internal 
phlegmons.  I except  the  mumps,  or  parotitis,  described  below; 
which  is  properly  an  external  gland,  as  its  excretory  duct  opens 
into  the  air.  When  pain  of  the  head  or  delirium  precedes  the 
cutaneous  eruption  of  the  face,  there  is  some  reason  to  believe, 
that  the  primary  disease  is  a torpor  of  the  meninges  of  the  brain; 
and  that  the  succeeding  violent  action  is  transferred  to  the  skin 
of  the  face  by  sensitive  association;  and  that  a similar  sympathy 
occurs  between  some  internal  membranes  and  the  skin  over  them, 
when  erysipelas  appears  on  other  parts  of  the  body.  If  this  cir- 
cumstance should  be  supported  by  further  evidence,  this  disease 
should  be  removed  into  Class  IV.  along  with  the  rheumatism 
and  gout.  See  Class  IV.  1.  2.  17. 

This  supposed  retropulsion  of  erysipelas  on  the  brain  from 
the  frequent  appearance  of  delirium,  has  prevented  the  free  use 
of  the  lancet  early  in  this  disease  to  the  destruction  of  many; 
as  it  has  prevented  the  subduing  of  the  general  inflammation, 
and  thus  has  in  the  end  produced  the  particular  one  on  the 
brain.  Mr.  B , a delicate  gentleman  about  sixty,  had  an  ery- 

sipelas beginning  near  one  ear,  and  extending  by  degrees  over 
the  whole  head,  with  hard,  full,  and  strong  pulse;  blood  was  ta- 


190 


DISEASES 


Class  II.  1.  3.  2. 


ken  from  him  four  or  five  times  in  considerable  quantity,  with 
gentle  cathartics,  with  calomel,  diluents,  and  cool  air,  and  he 
recovered  without  any  signs  of  delirium,  or  inflammation  of  the 

meninges  of  the  brain.  Mr.  W , a strong  corpulent 

man  of  inferior  life,  had  erysipelas  over  his  whole  head,  with 
strong  hard  pulse;  he  was  not  evacuated  early  in  the  disease 
through  the  timidity  of  his  apothecary,  and  died  delirious.  Mrs. 

F had  erysipelas  on  the  face,  without  either  strong  or  wreak 

pulse;  that  is,  with  sensitive  fever  alone,  without  superabun- 
dance or  deficiency  of  irritation;  and  recover, ed  without  any  but 
natural  evacuations.  From  these  three  cases  of  erysipelas  on  the 
head  it  appears  that  the  evacuations  by  the  lancet  must  be  used 
with  courage,  where  the  degree  of  inflammation  requires  it; 
but  not  where  this  degree  of  inflammation  is  small,  nor  in  the 
erysipelas  attended  with  inirritation,  as  described  below\ 

M.  M.  Venesection  repeated  according  to  the  degree  of  in- 
flammation. An  emetic.  Calomel,  three  grains  every  other 
night.  Cool  air.  Diluents,  emetic  tartar  in  small  doses,  as  a 
quarter  of  a grain  every  six  hours.  Tea,  weak  broth,  gruel,  le- 
monade, neutral  salts.  See  Sect.  XII.  6. 

Such  external  applications  as  carry  away  the  heat  of  the  skin 
may  be  of  service,  as  cold  water,  cold  flour,  snow,  ether.  Be- 
cause these  applications  impede  the  exertions  of  the  secerning 
vessels,  which  are  now  in  too  great  action;  but  any  applica- 
tions of  the  stimulant  kind,  as  solutions  of  lead,  iron,  copper, 
or  of  alum,  used  early  in  the  disease,  must  be  injurious;  as  they 
stimulate  the  secerning  vessels,  as  well  as  the  absorbent  vessels, 
into  greater  action;  exactly  as  occurs  when  stimulant  eye  wa- 
ters are  used  too  soon  in  ophthalmy.  See  Class  II.  1.  2.  2. 
But  as  the  cuticle  peels  off  in  this  case  after  the  inflammation  ceases, 
it  differs  from  ophthalmy;  and  stimulant  applications  are  not 
indicated  at  all,  except  rvhere  symptoms  of  gangrene  appear. 
For  as  a new  cuticle  is  formed  under  the  old  one,  as  under  a blis- 
ter, the  serous  fluid  between  them  is  a defence  to  the  new  cuti- 
cle, and  should  dry  into  a scab  by  exhalation  rather  than  be  re- 
absorbed. Hence  we  see  how  greasy  or  oily  applications,  and 
even  how  moist  ones,  are  injurious  in  erysipelas;  because  they 
prevent  the  exhalation  of  the  serous  effusion  between  the  old  and 
new  cuticle,  and  thus  retard  the  formation  of  the  latter. 

Erysipelas  inimtatum  differs  from  the  former  in  its  being  at- 
tended with  weak  pulse,  and  other  symptoms  of  sensitive  inir- 
ritated  fever.  The  feet  and  legs  are  particularly  liable  to  this 
erysipelas,  which  precedes  or  attends  the  sphacelus  or  mortifica- 
tion of  those  parts.  A great  and  long  coldness  first  affects  the 
limb,  and  the  erysipelas  on  the  skin  seems  to  occur  in  conse- 


Glass  II.  1.  3.  2. 


OF  SENSATION. 


191 


quence  of  the  previous  torpor  of  the  interior  membranes.  As 
this  generally  attends  old  age,  it  becomes  more  dangerous  in  pro- 
portion to  the  age,  and  also  to  the  habitual  intemperance  of  the 
patient  in  respect  to  the  use  of  fermented  or  spirituous  liquor. 

When  the  former  kind,  or  irritated  erysipelas,  continues  long, 
the  patient  becomes  so  weakened  as  to  be  liable  to  all  the  symp- 
toms of  this  inirritated  erysipelas;  especially  where  the  me- 
ninges of  the  brain  are  primarily  affected.  As  in  that  case,  after 
two  or  three  efforts  have  been  made  to  remove  the  returning 
periods  of  torpor  of  the  meninges  to  the  external  skin,  those 
meninges  become  inflamed  themselves,  and  the  patient  sinks  un- 
der the  disease;  in  a manner  similar  to  that  in  old  gouty  patients, 
where  the  torpor  of  the  liver  or  stomach  is  relieved  by  associa- 
tion of  the  inflammation  of  the  membranes  of  the  feet,  and  then 
of  other  joints,  and  lastly  the  power  of  association  ceasing  to  act, 
but  the  excess  of  sensation  continuing,  the  liver  or  stomach  re- 
mains torpid,  or  becomes  itself  inflamed,  and  the  patient  is  de- 
stroyed. 

M.  M.  Where  there  exists  a beginning  gangrene  of  the  ex- 
tremities, the  Peruvian  bark,  and  wine,  and  opium,  are  to  be 
given  in  large  quantities;  so  as  to  strengthen  the  patient,  but 
not  to  intoxicate,  or  to  impede  his  digestion  of  aliment,  as  men- 
tioned in  the  first  species  of  this  genus.  Class  II.  1.2.  1.  But 
where  the  brain  is  inflamed  or  oppressed,  which  is  known  either 
by  delirium,  with  quick  pulse;  or  by  stupor  and  slow  respira- 
tion, with  slow  pulse;  other  means  must  be  applied.  Such  as, 
first,  a fomentation  on  the  head  with  warm  water,  with  or  with- 
out aromatic  herbs,  or  salt  in  it,  should  be  continued  for  an  hour 
or  two  at  a time,  and  frequently  repeated.  A blister  may  also 
be  applied  on  the  head,  and  the  fomentation  nevertheless  occa- 
sionally repeated.  Internally  very  gentle  stimulants,  as  camphor 
one  grain  or  two  in  infusion  of  valerian.  Wine  and  water,  or 
small  beer,  weak  broth.  An  enema.  Six  grains  of  rhubarb  and 
one  of  calomel.  Afterwards  five  drops  of  tincture  of  opium, 
which  may  be  repeated  every  six  hours,  if  it  seems  of  service. 
Might  the  head  be  bathed  for  a minute  with  cold  water?  or  with 
ether?  or  vinegar? 

Erysipelas  sensitivum  is  a third  species,  differing  only  in  the  kind 
of  fever  which  attends  it,  which  is  simply  inflammatory,  or  sen- 
sitive, without  either  excess  of  irritation,  as  in  the  first  variety; 
or  the  defect  of  irritation,  as  in  the  second  variety;  all  these 
kinds  of  erysipelas  are  liable  to  return  by  periods  in  some  people, 
who  have  passed  the  middle  of  life,  as  at  periods  of  a lunation, 
or  two  lunations,  or  at  the  equinoxes.  When  these  periods  of 
Erysipelas  happen  to  women,  they  seem  to  supply  the  place  of 


192 


DISEASES 


Ciass  II.  1.  3.  3. 


the  receding  catamenia;  when  to  men,  I have  sometimes  be- 
lieved them  to  be  associated  with  a torpor  of  the  liver;  as  they 
generally  occur  in  those  who  have  drunk  vinous  spirit  exces- 
sively, though  not  opprobriously;  and  that  hence  they  supplythe 
place  of  periodical  piles,  or  gout,  or  gutta  rosea. 

M.  M.  As  the  fever  requires  no  management,  the  disease 
takes  its  progress  safely,  like  a modern  paroxysm  of  the  gout; 
but  in  this  case,  as  in  some  of  the  former,  the  erysipelas  does  not 
appear  to  be  a primary  disease,  and  should  perhaps  be  removed 
to  the  Class  of  Association. 

3.  Tonsillitis.  Inflammation  of  the  tonsils.  The  uncouth  term 
Cynanche  has  been  used  for  diseases  so  dissimilar,  that  I have  di- 
vided them  into  Tonsillitis  and  Parotitis;  and  hope  to  be  excused 
for  adding  a Greek  termination  to  a Latin  word,  as  one  of  those 
languages  may  justly  be  considered  as  a dialect  of  the  other. 
By  tonsillitis  the  inflammation  of  the  tonsils  is  principally  to  be 
understood;  but  as  all  inflammations  generally  spread  further 
than  the  part  first  affected;  so,  when  the  summit  of  the  wind- 
pipe is  also  much  inflamed,  it  may  be  termed  tonsillitis  trachea- 
lis,  or  croup.  See  Class  I.  1.  3.  4.  and  II.  1.  2.  4;  and  when 
the  summit  of  the  gullet  is  much  inflamed  along  with  the  tonsil, 
it  may  be  called  tonsillitis  pharyngea,  as  described  in  Dr.  Cullen’s 
Nosologia,  Genus  X.  p.  92.  The  inflammation  of  the  tonsils 
may  be  divided  into  three  kinds,  which  require  different  methods 
of  cure. 

Tonsillitis  interim.  Inflammation  of  the  internal  tonsil.  When 
the  swelling  is  so  considerable  as  to  produce  difficulty  of  breath- 
ing, the  size  of  the  tonsil  should  be  diminished  by  cutting  it  with 
a proper  lancet,  which  may  either  give  exit  to  the  matter  it  con- 
tains, or  may  make  it  less  by  discharging  a part  of  the  blood. 
This  kind  of  angina  is  frequently  attended  with  irritated  fever 
besides  the  sensitive  one,  which  accompanies  all  inflammation, 
and  sometimes  requires  venesection.  An  emetic  should  be  given 
early  in  the  disease,  as  by  its  inducing  the  retrograde  action  of 
the  vessels  about  the  fauces  during  the  nausea  it  occasions,  it 
may  eliminate  the  very  cause  of  the  inflammation;  which  may- 
have  been  taken  up  by  the  absorbents,  and  still  continue  in  the 
mouths  of  the  lymphatics  or  their  glands.  The  patient  should 
then  be  induced  to  swallow  some  aperient  liquid,  as  an  infusion 
of  senna,  so  as  to  induce  three  or  four  evacuations.  Gargles  of 
all  kinds  are  rather  hurtful,  as  the  action  of  using  them  is  liable 
to  give  pain  to  the  inflamed  parts;  but  the  patients  find  great 
relief  from  frequently  holding  warm  water  in  their  mouths,  and 
putting  it  out  again,  or  by  syringing  warm  w-ater  into  the  mouth, 
as  this  acts  like  a warm  bath,  or  fomentation  to  the  inflamed 


OF  SENSATION. 


193 


Class  II.  1.  3.  3. 

part.  Lastly,  some  mild  stimulant,  as  a weak  solution  of  salt 
and  water,  or  of  white  vitriol  and  water,  may  be  used  to  wash 
the  fauces  with  in  the  decline  of  the  disease,  to  expedite  the  ab- 
sorption of  the  new  vessels,  if  necessary,  as  recommended  in 
ophlhalmy. 

Tonsillitis  super ficialis.  Inflammation  of  the  surface  of  the 
tonsils.  As  the  tonsils  and  parts  in  their  vicinity  are  covered 
with  a membrane,  which,  though  exposed  to  currents  of  air,  is 
nevertheless  constantly  kept  moist  by  mucus  and  saliva,  and  is 
liable  to  diseases  of  its  surface  like  other  mucous  membranes,  as 
well  as  to  suppuration  of  the  internal  substance  of  the  gland; 
the  inflammation  of  its  surface  is  succeeded  by  small  elevated 
pustules  with  matter  in  them,  which  soon  disappears,  and  the 
parts  either  readily  heal,  or  ulcers  covered  with  sloughs  are  left 
on  the  surface. 

This  disease  is  generally  attended  with  only  sensitive  fever, 
and  therefore  is  of  no  danger,  and  may  be  distinguished  w'ith 
great  certainty  from  the  dangerous  inflammation  or  gangrene 
of  the  tonsils  at  the  height  of  the  small-pox,  or  scarlet  fever,  by 
its  not  being  attended  with  other  symptoms  of  those  diseases. 
One  emetic  and  a gentle  cathartic  are  generally  sufficient;  and  the 
frequent  swallowing  of  weak  broth,  or  gruel,  both  without  salt 
in  them,  relieves  the  patient,  and  absolves  the  cure.  When 
these  tumours  of  the  tonsils  frequently  return  I have  sometimes 
suspected  them  to  originate  from  the  absorption  of  putrid  matter 
from  decaying  teeth.  See  Class  I.  2.  3.  21.  and  II.  2.  2.  1. 

Tonsillitis  inirritata.  Inflammation  of  the  tonsils  with  sensi- 
tive inirritated  fever  is  a symptom  only  of  contagious  fever, 
W'hether  attended  with  scarlet  eruption,  or  with  confluent  small- 
pox, or  otherwise.  The  matter  of  contagion  is  generally  diffus- 
ed, not  dissolved  in  the  air;  and  as  this  is  breathed  over  the  mu- 
caginous  surface  of  the  tonsils,  the  contagious  atoms  are  liable 
to  be  arrested  by  the  tonsil;  which  therefore  becomes  the  nest 
of  the  future  disease,  like  the  inflamed  circle  round  the  inocu- 
lated puncture  of  the  arm  in  supposititious  small-pox.  The  swell- 
ing is  liable  to  suffocate  the  patient  in  small-pox,  and  to  become 
gangrenous  in  scarlet  fever,  and  some  other  contagious  fevers, 
which  have  been  received  in  this  manner.  The  existence  of  in- 
flammation of  the  tonsil  previous  to  the  scarlet  eruption,  as  the 
arm  inflames  in  the  inoculated  small-pox,  and  suppurates  before 
the  variolous  eruption,  should  be  a criterion  of  the  scarlet  fever 
being  taken  in  this  manner. 

M.  M.  All  the  means  which  strengthen  the  patient,  as  in 
the  sensitive  inirritated  fever,  Class  II.  1.2.  1.  As  it  is  liable 
to  continue  a wdiole  lunation  or  more,  great  attention  should  be 

vol.  n.  e c 


194 


DISEASES 


Class  II.  1.  3.  4. 


used  to  nourish  the  patient  with  acidulous  and  vinous  panada, 
broth  with  vegetables  boiled  in  it,  sugar,  cream,  beer;  all  which 
given  frequently  will  contribute  much  to  moisten,  clean,  and  heal 
the  ulcuscles,  or  sloughs,  of  the  throat;  warm  water  and  w’ine, 
or  acid  of  lemon,  should  be  frequently  applied  to  the  tonsils  by 
means  of  a syringe,  or  by  means  of  a capillary  syphon,  as  de- 
scribed in  Class  II.  1.  2.  1.  A slight  solution  of  blue  vitriol, 
as  two  grains  to  an  ounce,  or  a solution  of  sugar  of  lead  of  about 
six  grains  to  an  ounce,  may  be  of  service;  especially  the  latter, 
applied  to  the  edges  of  tbe  sloughs  drop  by  drop,  by  means  of 
a small  glass  tube,  or  small  crow-quill,  with  the  end  cut  off,  or 
by  a camel’s-hair  pencil  or  sponge;  to  the  end  of  either  of 
which  a drop  will  conveniently  hang  by  capillary  attraction;  as 
solutions  of  lead  evidently  impede  the  progress  of  erysipelas  on 
the  exterior  skin,  when  it  is  attended  with  feeble  pulse.  Yet  a 
solution  of  alum  injected  frequently  by  a syringe  is  perhaps  to 
be  preferred,  as  it  immediately  removes  the  fetor  of  tbe  breath, 
which  must  much  injure  the  patient  by  its  being  perpetually  re- 
ceived into  the  lungs  by  respiration. 

4.  Parotitis.  Mumps,  or  branks,  is  a contagious  inflamma- 
tion of  the  parotis  and  maxillary  glands,  and  has  generally  been 
classed  under  the  word  Cynanche  or  Angina,  to  which  it  bears 
no  analogy.  It  divides  itself  into  two  kinds,  which  differ  in  the 
degree  of  fever  which  attends  them,  and  in  the  method  of  cure. 

Parotitis  suppurans.  The  suppurating  mumps  is  to  be  distin- 
guished by  the  acuteness  of  the  pain,  and  the  sensitive,  irritated, 
or  inflammatory  fever,  which  attends  it. 

M.  M.  Venesection.  Cathartic  with  calomel  three  or  four 
grains  repeatedly.  Cool  air,  diluents.  This  antiphlogistic  treat- 
ment is  to  be  continued  no  longer  than  is  necessary  to  relieve 
the  violence  of  the  pain,  as  the  disease  is  attended  with  conta- 
gion, and  must  run  through  a certain  time,  like  other  fevers 
with  contagion. 

Parotitis  mutabilis.  Mutable  parotitis.  A sensitive  fever  only, 
or  a sensitive  irritated  fever,  generally  attends  this  kind.  And 
when  the  tumour  of  the  parotis  and  maxillary  glands  subsides, 
a new  swelling  occurs  in  some  distant  part  of  the  system;  as 
happens  to  the  hands  and  feet,  at  the  commencement  of  the  se- 
condary fever  of  the  small-pox,  when  the  tumour  of  the  face  sub- 
sides. This  new  swelling  in  the  parotitis  mutabilis  is  liable  to 
affect  the  testes  in  men,  and  form  a painful  tumour,  which  should 
be  prevented  from  suppuration  by  very  cautious  means,  if  the 
violence  of  the  pain  threaten  such  a termination;  as  by  bathing 
the  part  with  coldish  water  for  a time,  venesection,  a cathartic; 
or  by  a blister  on  the  perinaeum,  or  scrotum,  or  a poultice. 


CiASS  II,  1.  3. 4. 


OF  SENSATION. 


195 


When  women  are  affected  with  this  complaint,  after  the  swell- 
ing of  the  parotis  and  maxillary  glands  subsides,  tumour  with  pain 
is  liable  to  affect  their  breasts;  which,  however,  I have  never 
seen  terminate  in  suppuration. 

On  the  retrocession  of  the  tumour  of  the  testes  above  described, 
and  I suppose  of  that  of  the  breasts  in  women,  a delirium  of  the 
calm  kind  is  very  liable  to  occur;  which  in  some  cases  has  been 
the  first  symptom  which  has  alarmed  the  friends  of  the  patient; 
and  it  has  thence  been  difficult  to  discover  the  cause  of  it  without 
much  inquiry;  the  previous  symptoms  having  been  so  slight  as 
not  to  have  occasioned  any  complaints.  In  this  delirium,  if  the 
pulse  will  bear  it,  venesection  should  be  used,  and  three  or  four 
grains  of  calomel,  with  fomentation  of  the  head  with  warm  water 
for  an  hour  together  every  three  or  four  hours. 

Though  this  disease  generally  terminates  favourably,  consider- 
ing the  numbers  attacked  by  it,  when  it  is  epidemic,  yet  it  is  dan- 
gerous at  other  limes  in  every  part  of  its  progress.  Sometimes 
the  parotis  or  maxillary  glands  suppurate,  producing  ulcers  which 
are  difficult  to  cure,  and  frequently  destroy  the  patient,  where 
there  was  a previous  scrofulous  tendency.  The  testes  in  men  is 
also  liable  to  suppurate  with  great  pain,  long  confinement,  and 
much  danger;  and  lastly,  the  affection  of  the  brain  is  fatal  to 
many. 

Mr.  W.  W.  had  a swelled  throat,  which  after  a few  days  sub- 
sided. He  became  delirious  or  stupid,  in  which  state  he  was 
dying  when  I saw  him;  and  his  friends  ascribed  his  death  to  a 
coup  de  soldi , which  he  was  said  to  have  received  some  months 
before,  when  he  was  abroad. 

Mr.  A.  B.  had  a swelling  of  the  throat,  which  after  a few  days 
subsided.  When  I saw  him  he  had  great  stupor,  with  slow 
breathing,  and  partial  delirium.  On  fomenting  his  head  with 
warm  water  for  an  hour,  these  symptoms  of  stupor  were  greatly 
lessened,  and  his  oppressed  breathing  gradually  ceased,  and  he 
recovered  in  one  day. 

Mr.  C.  D.  I found  walking  about  the  house  in  a calm  deli- 
rium without  stupor;  and  not  without  much  inquiry  of  his  friends 
could  get  the  previous  history  of  the  disease;  which  had  been 
attended  with  parotitis,  and  swelled  testes,  previous  to  the  deli- 
rium. A few  ounces  of  blood  were  taken  away,  a gentle  ca- 
thartic was  directed,  and  his  head  fomented  with  warm  water 
for  an  hour,  with  a small  blister  on  the  back,  and  he  recovered  in 
two  or  three  days. 

Mr.  D.  D.  came  down  from  London  in  the  coach  alone,  so 
that  no  previous  history  could  be  obtained.  He  was  walking 
about  the  house  in  a calm  delirium,  but  could  give  no  sensible 


196 


DISEASES 


Class  II.  1.  3.  5 


answers  to  any  thing  which  was  proposed  to  him.  His  pulse  was 
weak  and  quick.  Cordials,  a blister,  the  bark,  were  in  vain  ex- 
hibited, and  he  died  in  two  or  three  days. 

Mr.  I'.  F.  came  from  London  in  the  same  manner  in  the  coach. 
He  was  mildly  delirious  with  considerable  stupor,  and  moderate 
pulse,  and  could  give  no  account  of  himself.  He  continued  in  a 
kind  of  cataleptic'stupor,  so  that  he  would  remain  for  hours  in 
any  posture  he  was  placed,  either  in  bis  chair,  or  in  bed;  and  did 
not  attempt  to  speak  for  about  a fortnight,  and  then  gradually  re- 
covered. These  tw7o  last  cases  are  not  related  as  being  certainly 
owing  to  parotitis,  but  as  they  might  probably  have  that  origin. 

The  parotitis  suppurans,  or  mumps  with  irritated  fever,  is  at 
times  epidemic  among  cats,  and  may  be  called  parotitis  felina;  as 
I have  reason  to  believe  from  the  swellings  under  the  jaws, 
which  frequently  suppurate,  and  are  very  fatal  to  those  animals. 
In  the  village  of  Haywood,  in  Staffordshire,  I remember  a whole 
breed  of  Persian  cats,  with  long  white  hair,  wras  destroyed  by 
this  malady,  along  with  almost  all  the  common  cats  of  the  neigh- 
bourhood; and  as  the  parotitis  or  mumps  had  not  long  before 
prevailed  amongst  human  beings  in  that  part  of  the  country,  I 
recollect  being  inclined  to  believe,  that  the  cats  received  the  in- 
fection from  mankind;  though  in  all  other  contagious  diseases, 
except  the  rabies  canina  can  be  so  called,  no  different  genera  of 
animals  naturally  communicate  infection  to  each  other;  and  I am 
informed,  that  vain  efforts  have  been  made  to  communicate  the 
small-pox  and  measles  to  some  quadrupeds  by  inoculation.  A 
disease  of  the  head  and  neck  destroyed  almost  all  the  cats  in 
Westphalia.  Sauvage,  Nosol.  Class  X.  Art.  30.  8. 

Since  the  above  was  first  published,  the  cow  pox,  variolas  vac- 
cinae,  has  been  successfully  inoculated  on  the  human  subject, 
and  produced  a disease  in  some  respects  similar  to  the  small-pox. 
See  Variolas. 

5.  Catarrlius  sensitivus  consists  of  an  inflammation  of  the 
membrane,  which  lines  the  nostrils  and  fauces.  It  is  attended 
with  sensitive  fever  alone,  and  is  cured  by  the  steam  of  warm 
water  externally,  and  by  diluents  internally,  with  moderate  vene- 
section and  gentle  cathartics.  This  may  be  termed  catarrlius 
sensitivus,  to  distinguish  it  from  the  catarrlius  contagiosus,  and  is 
in  common  language  called  a violent  cold  in  the  head;  it  differs 
from  the  catarrlius  calidus,  or  warm  catarrh,  of  Class  I.  1 . 2.  7. 
in  the  production  of  new  vessels,  or  inflammation  of  the  mem- 
brane, and  the  consequent  more  purulent  appearance  of  the  dis- 
eharge. 

Raucedo  catarrhalis,  or  catarrhal  hoarseness,  is  a frequent  symp- 


Class  II.  1.  3.  6. 


OF  SENSATION. 


197 


tom  of  this  disease,  and  is  occasioned  by  the  pain  or  soreness 
which  attends  the  thickened  and  inflamed  membranes  of  the 
larynx;  which  prevents  the  muscles  of  vocality  from  sufficiently 
contracting  the  aperture  of  it.  It  ceases  with  the  inflammation, 
or  may  be  relieved  by  the  steam  of  warm  water  alone,  or  of  wa- 
ter and  vinegar,  or  of  water  and  ether.  See  Paralytic  Hoarse- 
ness, Class  III.  2.  1.4. 

6.  Catarrhus  contagiosus.  This  malady  attacks  so  many  at 
the  same  time,  and  spreads  gradually  over  so  great  an  extent  of 
country,  that  there  can  be  no  doubt  but  that  it  is  disseminated  by 
the  atmosphere.  In  the  year  1782  the  sun  was  for  many  weeks 
obscured  by  a dry  fog,  and  appeared  red  as  through  a common 
mist.  The  mate-rial  which  thus  rendered  the  air  muddy,  probably 
caused  the  epidemic  catarrh,  which  prevailed  in  that  year,  and 
which  began  far  in  the  north,  and  extended  itself  over  all  Europe. 
See  Botanic  Garden,  Vol.  II.  note  on  Chunda,  and  Vol.  I.  Canto 
IV.  line  294,  note;  and  was  supposed  to  have  been  thrown  out  of 
a volcano,  which  much  displaced  the  country  of  Iceland. 

In  many  instances  there  was  reason  to  believe  that  this  disease 
became  contagious,  as  well  as  epidemic;  that  is,  that  one  person 
might  receive  it  from  another,  as  well  as  by  the  general  unsalu- 
tary  influence  of  the  atmosphere.  This  is  difficult  to  compre- 
hend, but  may  be  conceived  by  considering  the  increase  of  conta- 
gious matter  in  the  small-pox.  In  that  disease  one  particle  of 
contagious  matter  stimulates  the  skin  of  the  arm  in  inoculation 
into  morbid  action  so  as  to  produce  a thousand  particles  similar 
to  itself;  the  same  thing  occurs  in  catarrh,  a few  deleterious 
atoms  stimulate  the  mucous  membrane  of  the  nostrils  into  mor- 
bid actions,  which  produce  a thousand  other  particles  similar  to 
themselves.  These  contagious  particles  diffused  in  the  air  must 
have  consisted  of  animal  matter,  othenvise  how  could  an  animal 
body  by  being  stimulated  by  them  produce  similar  particles? 
Could  they  then  have  had  a volcanic  origin,  or  must  they  not  ra- 
ther have  been  blown  from  putrid  marshes  full  of  animal  matter? 
But  the  greatest  part  of  the  solid  earth  has  been  made  from  ani- 
mal and  vegetable  recrements,  which  may  be  dispersed  by  vol- 
canoes.— Future  discoveries  must  answer  these  questions. 

As  the  sensitive  fever  attending  these  epidemic  catarrhs  is  sel- 
dom either  much  irritated  or  inirritated,  venesection  is  not  al- 
ways either  clearly  indicated  or  forbidden;  but  as  those  who 
have  died  of  these  catarrhs  have  generally  had  inflamed  livers, 
with  consequent  suppuration  in  them,  venesection  is  advisable, 
wherever  the  cough  and  fever  are  greater  than  common,  so  as  to 
render  the  use  of  the  lancet  in  the  least  dubious.  And  in  some 
cases  a second  bleeding  was  necessary,  and  a mild  cathartic  or 


198 


DISEASES 


©IASS  II.  1.  O.  6. 


two  with  four  grains  of  calomel;  with  mucilaginous  subacid  di- 
luents; and  warm  steam  occasionally  to  alleviate  the  cough, 
finished  the  cure. 

The  catarrhus  contagiosus  is  a frequent  disease  amongst  horses 
anti  dogs;  it  seems  first  to  be  disseminated  amongst  these  ani- 
mals by  miasmata  diffused  in  the  atmosphere,  because  so  many  of 
them  receive  it  at  the  same  time;  and  afterwards  to  be  commu- 
nicable from  one  horse  or  dog  to  another  by  contagion,  as  above 
described.  These  epidemic  or  contagious  catarrhs  more  fre- 
quently occur  amongst  dogs  and  horses  than  amongst  men; 
which  is  probably  owing  to  the  greater  extension  and  sensibility 
of  the  mucous  membrane,  which  covers  the  organ  of  smell,  and 
is  diffused  over  their  wide  nostrils,  and  their  large  maxillary  and 
frontal  caviiies.  And  to  this  circumstance  may  be  ascribed  the 
greater  fatality  of  it  to  these  animals. 

In  respect  to  horses,  I suspect  the  fever  at  the  beginning  to  be 
of  the  sensitive,  irritated,  or  inflammatory  kind,  because  there  is 
so  great  a discharge  of  purulent  mucus;  and  that  therefore  they 
will  bear  once  bleeding  early  in  the  disease;  and  also  one  mild 
• purgative,  consisting  of  about  half  an  ounce  of  aloe,  and  as  much 
white  hard  soap,  mixed  together.  They  should  be  turned  out  to 
grass  both  day  and  night  for  the  benefit  of  pure  air,  unless  the 
weather  be  too  cold,  (and  in  that  case  they  should  be  kept  in  an 
open  airy  stable,  without  being  tied,)  that  they  may  hang  down 
their  heads  to  facilitate  the  discharge  of  the  mucus  from  their 
nostrils.  Grass  should  be  offered  them,  or  other  fresh  vegeta- 
bles, as  carrots  and  potatoes,  with  mashes  of  malt,  or  of  oats,  and 
with  plenty  of  fresh  warm  or  cold  water  frequently  in  a day. 
When  symptoms  of  debility  appear,  which  may  be  known  by  the 
coldness  of  the  ears  or  other  extremities,  or  when  sloughs  can  be 
seen  on  the  membrane,  which  lines  the  nostrils,  a drink  consist- 
ing of  a pint  of  ale  with  half  an  ounce  of  tincture  of  opium  in  it, 
given  every  six  hours,  is  likely  to  be  of  great  utility. 

In  dogs  I believe  the  catarrh  is  generally  joined  with  symp- 
toms of  debility  early  in  the  disease.  These  animals  should  be 
permitted  to  go  about  in  the  open  air,  and  should  have  constant 
access  to  fresh  water.  The  use  of  being  as  much  as  may  be  in 
the  air  is  evident,  because  all  the  air,  which  they  breathe,  passes 
twice  over  the  putrid  sloughs  of  the  mortified  parts  of  the  mem- 
brane, which  lines  the  nostrils,  and  the  maxillary  and  frontal 
cavities;  that  is,  both  during  inspiration  and  expiration;  and 
must  therefore  be  loaded  with  coutagious  particles.  Fresh  new 
milk,  and  fresh  broth,  should  be  given  them  very  frequently,  and 
they  should  be  suffered  to  go  amongst  the  grass,  which  they  some- 
times eat  for  the  purpose  of  an  emetic;  and  if  possible  should 


Siass  II.  1 .3.7. 


OF  SENSATION. 


199 


have  access  to  a running  stream  of  water.  As  the  contagious 
mucus  of  the  nostrils,  both  of  these  animals  and  of  horses,  gener- 
ally drops  into  the  water,  they  attempt  to  drink.  Bits  of  raw 
flesh,  if  the  dog  will  eat  them,  are  preferred  to  cooked  meat;  and 
from  five  to  ten  drops  of  tincture  of  opium  may  be  given  with  ad- 
vantage, when  symptoms  of  debility  are  evident,  according  to  the 
size  of  the  dog,  every  six  hours.  If  sloughs  can  be  seen  in  the 
nostrils,  they  should  be  moistened  twice  a day,  both  in  horses 
and  dogs,  with  a solution  of  sugar  of  lead,  or  of  alum,  by  means 
of  a sponge  fixed  on  a bit  of  whale-bone,  or  by  a syringe.  The 
lotion  may  be  made  by  dissolving  half  an  ounce  of  sugar  of  lead, 
or  of  alum,  in  a pint  of  water. 

Ancient  philosophers  seem  to  have  believed,  that  the  conta- 
gious miasmata  in  their  warm  climates  affected  horses  and  dogs 
previous  to  mankind.  If  those  contagious  particles  were  sup- 
posed to  be  diffused  amongst  the  heavy  inflammable  air,  or  car- 
bonated hydrogen,  or  putrid  marshes,  as  these  animals  hold  their 
heads  down  lower  to  the  ground,  they  may  be  supposed  to  have 
received  them  sooner  than  men.  And  though  men  and  quadru- 
peds might  receive  a disease  from  the  same  source  of  marsh-pu- 
trefaction, they  might  not  afterwards  be  able  to  infect  each  other, 
though  they  might  infect  other  animals  of  the  same  genus;  as  the 
new  contagious  matter  generated  in  their  own  bodies  might  not 
be  precisely  similar  to  that  received;  as  happened  in  the  jail- 
fever  at  Oxford,  where  those  who  took  the  contagion  and  died, 
did  not  infect  others. 

On  mules  and  dogs  the  infection  first  began. 

And,  last,  the  vengeful  arrows  fix’d  on  man. 

Pope’s  Homer’s  Iliad,  I. 

7.  Peripneumonia  superjicialis.  The  superficial  or  spurious 
peripneurnony  consists  in  an  inflammation  of  the  membrane, 
which  lines  the  bronchia,  and  bears  the  same  analogy  to  the  true 
peripneurnony,  as  the  inflammations  of  other  membranes  do  to 
that  of  the  parenchyma,  or  substantial  parts  of  the  viscus,  which 
they  surround.  It  affects  elderly  people,  and  frequently  occa- 
sions their  death;  and  exists  at  the  end  of  the  true  peripneurnony, 
or  along  with  it;  when  the  lancet  has  not  been  used  sufficiently 
to  cure  by  reabsorbing  the  inflamed  parts,  or  what  is  termed  by 
resolution. 

M.  M.  Diluents,  mucilage,  antimonials,  warmish  air  con- 
stantly changed,  venesection  once,  perhaps  twice,  if  the  pulse 
will  bear  it.  Oily  volatile  draughts.  Balsams?  Neutral  salts 
increase  the  tendency  to  cough.  Blisters  in  succession  about  the 
chest.  Warm  bath.  Mild  purgatives.  Very  weak  chicken 


200 


DISEASES 


Class  II.  1.  3.  8 


broth  without  salt  in  it.  Boiled  onions.  One  grain  of  calomel 

every  night  for  a week.  From  five  drops  to  ten  of  tincture  of 

opium  at  six  every  night,  when  the  patient  becomes  weak. 
Digitalis?  See  Class  II.  1.  6.  7. 

8.  Pertussis.  Tussis  convulsiva.  Chin-cough  resembles  pe- 
ripneumonia superficialis  in  its  consisting  in  an  inflammation  of 
the  membrane  which  lines  the  air-vessels  of  the  lungs;  but  differs 
in  the  circumstance  of  its  being  contagious;  and  is  on  that  ac- 
count of  very  long  duration;  as  the  whole  of  the  lungs  are  pro- 
bably not  infected  at  the  same  time,  but  the  contagious  inflamma- 
tion continues  gradually  to  creep  on  the  membrane.  It  may  in 
this  respect  be  compared  to  the  ulcers  in  the  pulmonary  consump- 
tion; but  it  differs  in  this,  that  in  chin-cough  some  branches  of  the 
bronchia  heal,  as  others  become  inflamed. 

This  complaint  is  not  usually  classed  amongst  febrile  disorders, 
but  a sensitive  fever  may  generally  be  perceived  to  attend  it  dur- 
ing some  part  of  the  day,  especially  in  weak  patients.  And  a 
peripneumony  very  frequently  supervenes,  and  destroys  great 
numbers  of  children,  except  the  lancet  or  four  or  six  leeches  be 
immediately  and  repeatedly  used.  When  the  child  has  permanent 
difficulty  of  breathing,  which  continues  between  the  coughing 
fits,  unless  blood  be  taken  from  it,  it  dies  in  two,  three,  or  four 
days  of  the  inflammation  of  the  lungs.  During  this  permanent 
difficulty  of  breathing,  the  hooping  cough  abates,  or  quite 
ceases,  and  returns  again  after  once  or  twice  bleeding;  which 
is  then  a good  symptom,  as  the  child  now  possessing  the  power 
to  cough  shews  the  difficulty  of  breathing  to  be  abated.  1 dwell 
longer  upon  this,  because  many  lose  their  lives  from  the  difficulty 
there  is  in  bleeding  young  children;  where  the  apothecary  is  old 
or  clumsy,  or  is  not  furnished  with  a very  sharp  and  fine  pointed 
lancet.  In  this  distressing  situation  the  application  of  four  leeches 
to  one  of  the  child’s  legs,  the  wounds  made  by  which  should  con- 
tinue to  bleed  an  hour  or  two,  is  a succedaneum;  and  saves  the 
patient,  if  repeated  once  or  twice,  according  to  the  difficulty  of 
the  respiration. 

The  chin-cough  seems  to  resemble  the  gonorrhoea  venerea  in 
several  circumstances.  They  are  both  received  by  infection,  are 
both  diseases  of  the  mucous  membrane,  are  both  generally  cured 
in  four  or  six  weeks  without  medicine.  If  ulcers  in  the  cellular 
membrane  under  the  mucous  membrane  occur,  they  are  of  a 
phagedenic  kind,  and  destroy  the  patient  in  both  diseases,  if  no 
medicine  be  administered. 

Hence  the  cure  should  be  similar  in  both  these  diseases;  first 
oeneral  evacuations  and  diluents,  then,  alter  a week  or  two,  I 
have  believed  the  following  pills  of  great  advantage.  The  dose 


Glass  II.  1.  3.  9. 


OF  SENSATION, 


201 


for  a child  of  about  three  years'old  was  one-sixth  part  of  a grain 
of  calomel,  one-sixth  part  of  a grain  of  opium,  and  two  grains  of 
rhubarb,  to  be  taken  twice  a day. 

The  opium  promotes  absorption  from  the  mucous  membrane, 
and  hence  contributes  to  heal  it.  The  mercury  prevents  ulcers 
from  being  formed  under  the  mucous  membrane,  or  cures  them, 
as  in  the  lues  venerea;  and  the  rhubarb  is  necessary  to  keep  the 
bowels  open. 

M.  M.  Antimonial  vomits  frequently  repeated.  Mild  cathar- 
tics. Cool  air.  Tincture  of  cantharides,  or  repeated  blisters; 
afterwards  opiates  in  small  doses,  and  the  bark.  Warm  bath 
frequently  used.  The  steam  of  warm  water  with  a little  vinegar 
in  it  may  be  inhaled  twice  a day.  Thirty  drops  of  saturated  tinc- 
ture of  digitalis  purpurea,  purple  foxglove,  were  given  twice  a 
day  to  a lady,  seventy  years  of  age,  in  this  disease,  with  great 
and  almost  immediate  advantage.  I have  since  given  from  five 
to  ten  drops  twice  a day  to  two  children,  with  also  great  appa- 
rent advantage.  See  Art.  IY.  2.  3.  7.  Arsenic  has  lately  been 
recommended  in  the  hooping  cough.  See  Art.  IY.  2.  6.  9.  And 
externally  a solution  of  20  grains  of  emetic  tartar,  antimonium 
tartarisatum,  in  two  ounces  of  water,  to  which  is  to  be  added  one 
ounce  of  tincture  of  cantharides,  is  recommended,  by  Dr.  Struve 
of  America,  to  be,  rubbed  very  frequently  on  the  region  of  the 
stomach.  Could  the  breathing  of  carbonic  acid  gas  mixed  with 
atmospheric  air  be  of  service?  Copious  venesection,  when  a diffi- 
culty of  breathing  continues  between  the  fits  of  coughing;  other- 
wise the  cough  and  the  expectoration  cease,  and  the  patient  is 
destroyed.  Ulcers  of  the  lungs  sometimes  supervene,  and  the 
phthisis  pulmonalis  in  a few  weeks  terminates  in  death.  Where 
the  cough  continues  after  some  weeks  without  much  of  the  hoop- 
ing,  and  a sensitive  fever  daily  supervenes,  so  as  to  resemble 
hectic  fever  from  ulcers  of  the  lungs;  change  of  air  for  a week 
or  fortnight  acts  as  a charm,  and  restores  the  patient  beyond  the 
hopes  of  the  physician. 

Young  children  should  lie  with  their  heads  and  shoulders  rais- 
ed; and  should  be  constantly  watched  day  and  night;  that  when 
the  cough  occurs,  they  may  be  held  up  easily,  so  as  to  stand  upon 
their  feet  bending  a little  forwards;  or  nicely  supported  in  that  pos- 
ture which  they  seem  to  put  themselves  into.  A bow  of  whalebone, 
about  the  size  of  the  bow  of  a key,  is  , ery  useful  to  extract  the 
phlegm  out  of  the  mouths  of  infants  at  ..be  time  of  their  coughing; 
as  a handkerchief,  if  applied  at  the  time  of  their  quick  inspirations 
after  long  holding  their  breath  is  dangerous,  and  may  suffocate 
the  patient  in  an  instant,  as  I believe  has  sometimes  happened. 

9.  Variola  discreta.  The  small-pox  is  well  divided  bv  Syden- 
vot.  ii.  v d 


m 


MSEASES 


Ciis3ll.  1.  3.  S'. 


ham  into  distinct  and  confluent.  The  former  consists  of  distinct 
pustules,  which  appear  on  the  fourth  day  of  the  fever,  are  cir- 
cumscribed and  turgid;  the  fever  ceasing  when  the  eruption  is 
complete.  Head-ach,  pain  in  the  loins,  vomiting  frequently, 
and  convulsive  fits  sometimes  precede  the  eruption. 

The  distinct  small-pox  is  attended  with  sensitive  fever  only, 
when  very  mild,  as  in  most  inoculated  patients;  or  with  sensi- 
tive irritated  fever,  when  the  disease  is  greater:  the  danger  in 
this  kind  of  small-pox  is  owing  either  to  the  tumour  and  soreness 
of  the  throat  about  the  height,  or  eighth  day  of  the  eruption; 
or  to  the  violence  of  the  secondary  fever.  For,  first,  as  the  natu 
ral  disease  is  generally  taken  by  particles  of  the  dust  of  the  con- 
tagious matter  dried  and  floating  in  the  air,  these  are  liable  to  be 
arrested  by  the  mucus  about  the  throat  and  tonsils  in  their  passage 
to  the  lungs,  or  to  the  stomach,  when  they  are  previously  mixed 
with  saliva  in  the  mouth  Hence  the  throat  inflames  like  the 
arm  in  inoculated  patients;  and  this  increasing,  as  the  disease 
advances,  destroys  the  patient  about  the  height. 

Secondly,  all  those  upon  the  face  and  head  come  out  about 
the  same  time,  namely,  about  one  day  before  those  on  the  hands, 
and  two  before  those  in  the  trunk;  and  thence,  when  the  head 
is  very  full,  a danger  arises  from  the  secondary  fever,  which  is  a 
purulent  not  a variolous  fever;  for  as  the  matter  from  all  these 
of  the  face  and  head  is  reabsorbed  at  the  same  time,  the  patient 
is  destroyed  by  the  violence  of  this  purulent  fever;  which  in  the 
distinct  small-pox  can  only  be  abated  by  venesection  and  cathar- 
tics; but  in  the  confluent  small-pox  requires  cordials  and  opiates, 
as  it  is  attended  with  arterial  debility.  See  Sect.  XXXV.  1.  and 
XXXIII.  2.  10. 

When  the  pustules  on  the  face  recede,  the  face  swells;  and 
when  those  of  the  hands  recede,  the  hands  swell;  and  the  same 
of  the  feet  in  succession.  These  swellings  seem  to  be  owing  to 
the  absorption  of  variolous  matter,  which,  by  its  stimulus,  excites 
the  cutaneous  vessels  to  secrete  more  lymph,  or  serum,  or  mucus, 
exactly  as  happens  by  the  stimulus  of  a blister.  Now,  as  a blister 
sometimes  produces  strangury  many  hours  after  it  has  risen,  it 
is  plain,  that  a part  of  the  cantharides  is  absorbed,  and  carried  to 
the  neck  of  the  bladder;  whether  it  enters  the  circulation,  or  is 
carried  thither  by  retrograde  movements  of  the  urinary  branch 
of  lymphatics;  and  by  parity  of  reasoning  the  variolous  matter 
is  absorbed,  and  swells  the  face  and  hands  by  its  stimulus. 

Variola  conjluens.  The  confluent  small-pox  consists  of  nume- 
rous pustules,  which  appear  on  the  third  day  of  the  fever,  flow 
together,  are  irregularly  circumscribed,  flaccid,  and  little  ele- 
vated, the  fever  continuing  after  the  eruption  is  complete;  con 


OF  SENSATION. 


Cxass  II.  1.  3.  9. 


203 


vulsions  do  not  precede  this  kind  of  small-pox,  and  are  so  far  to 
be  esteemed  a favourable  symptom. 

The  confluent  small-pox  is  attended  with  sensitive  inirritated 
fever,  or  inflammation  with  arterial  debility;  whence  the  dan- 
ger of  this  disease  is  owing  to  the  general  tendency  to  gangrene, 
with  petechiae,  or  purple  spots,  and  haemorrhages;  besides  the 
two  sources  of  danger  from  the  tumour  of  the  throat  about  the 
height,  or  eleventh  day  of  the  eruption,  and  the  purulent  fever 
after  that  time;  which  are  generally  much  more  to  be  dreaded 
in  this  than  in  the  distinct  small-pox  described  above. 

M M.  The  method  of  treatment  must  vary  with  the  degree 
and  kind  of  fever.  Venesection  may  be  used  in  the  distinct 
small-pox  early  in  the  disease,  according  to  the  strength  or  hard- 
ness of  the  pulse;  and  perhaps  on  the  first  day  of  the  confluent 
small-pox,  and  even  of  the  plague,  before  the  sensorial  power  is 
exhausted  by  the  violence  of  the  arterial  action?  Cold  air,  and 
even  washing  or  bathing  in  cold  water,  is  a powerful  means  in 
perhaps  all  eruptive  diseases  attended  with  fever;  as  the  quan- 
tity of  eruption  depends  on  the  quantity  of  the  fever,  and  the 
activity  of  the  cutaneous  vessels;  which  may  be  judged  of  by 
the  heat  produced  on  the  skin;  and  which  latter  is  immediately 
abated  by  exposure  to  external  cold.  Mercurial  purges,  as  three 
grains  of  calomel  repeated  every  day  during  the  eruptive  fever, 
so  as  to  induce  three  or  four  stools,  contribute  to  abate  inflam- 
mation; and  is  believed  by  some  to  have  a specific  effect  on  the 
variolous,  as  it  is  supposed  to  have  on  the  venereal  contagion. 

It  has  been  said,  that  opening  the  pock  and  taking  out  the 
matter  has  not  abated  the  secondary  fever;  but  as  I had  conceiv- 
ed that  the  pits  or  marks,  left  after  the  small-pox,  were  owing 
to  the  acrimony  of  the  matter  beneath  the  hard  scabs,  which, 
not  being  able  to  exhale,  eroded  the  skin,  and  produced  ulcers, 

I directed  the  faces  of  two  patients  in  the  confluent  small-pox 
to  be  covered  with  cerate  early  in  the  disease,  which  was  daily 
renewed;  and  I was  induced  to  think,  that  they  had  much  less 
of  the  secondary  fever,  and  were  so  little  marked,  that  one  of 
them,  who  was  a young  lady,  almost  entirely  preserved  her 
beauty.  Perhaps  mercurial  plasters,  or  cerates,  made  without 
turpentine  in  them,  might  have  been  more  efficacious  in  pre- 
venting the  marks,  and  especially  if  applied  early  in  the  disease, 
even  on  the  first  day  of  the  eruption,  and  renewed  daily.  For 
it  appears  from  the  experiments  of  Van  Woensel,  that  calomel 
or  corrosive  sublimate,  triturated  with  variolous  matter,  incapaci- 
tates it  from  giving  the  disease  by  inoculation.  Calomel  or 
sublimate  given  as  an  alterative  for  ten  days  before  inoculation, 
and  till  the  eruptive  fever  commences,  is  said  with  certainty  to 


204 


DISEASES 


Class  II.  1.  3.  9. 


render  the  disease  mild  by  the  same  author.  Exper.  on  Mercu- 
Ty  by  Van  Woensel,  translated  by  Dr.  Fowle,  Salisbury. 

C.Dessarts,  in  the  sitting  of  the  French  national  institute,  is  said 
to  have  adduced  a number  of  facts  to  prove,  that  the  natural 
small-pox  is  rendered  much  milder  by  the  use  of  mercurial  remt 
dies;  which  I suppose  is  probably  true,  as  mercurials  increase 
the  absorption  in  many  other  ulcers,  and  consequently  diminish 
the  acrimony  of  the  matter,  and  forward  their  healing. 

Variola  inocvlata.  The  world  is  much  indebted  to  the  great 
discoverer  of  the  good  effects  of  inoculation,  whose  name  is  un- 
known; and  our  own  country  to  lady  Wortley  Montague  for 
its  introduction  into  this  part  of  Europe.  By  inserting  the  vario- 
lous contagion  into  the  arm,  it  is  not  received  by  the  tonsils,  as 
generally  happens,  I suppose,  in  the  natural  small-pox;  whence 
there  is  no  dangerous  swelling  of  the  throat,  and  as  the  pustules 
are  generally  few  and  distinct,  there  is  seldom  any  secondary 
fever;  whence  those  two  sources  of  danger  are  precluded; 
hence  when  the  throat  in  inoculated  small-pox  is  much  inflam- 
ed and  swelled,  there  is  reason  to  believe,  that  the  disease  had 
been  previously  taken  by  the  tonsils  in  the  natural  way:  which 
also,  I suppose,  has  generally  happened,  where  the  confluent 
kind  of  small-pox  has  occurred  on  inoculation. 

I have  known  two  instances,  and  have  heard  of  others,  where 
the  natural  small-pox  began  fourteen  days  after  the  contagion 
had  been  received;  one  of  these  instances  was  of  a countryman, 
who  went  to  a market-town  many  miles  from  his  home,  where 
he  saw  a person  in  the  small-pox,  and  on  returning  the  fever 
commenced  that  day  fortnight:  the  other  was  of  a child,  whom 
the  ignorant  mother  carried  to  another  child  ill  of  the  small-pox, 
on  purpose  to  communicate  the  disease  to  it;  and  the  variolous 
fever  began  on  the  fourteenth  day  from  that  time.  So  that  in 
both  these  cases  fever  commenced  in  half  a lunation  after  the 
contagion  was  received.  In  the  inoculated  small-pox  the  fever 
generally  commences  on  the  seventh  day;  or  after  a quarter  of 
a lunation;  and  on  this  circumstance  probably  depends  the 
greater  mildness  of  the  latter.  The  reason  of  which  is  difficult 
to  comprehend;  but  supposing  the  facts  to  be  generally  as  above 
related,  the  slower  progress  of  the  contagion  indicates  a greater 
inirritability  of  the  system,  and  in  consequence  a tendency  to 
malignant  rather  than  to  inflammatory  fever.  This  difference  of 
the  time  between  the  reception  of  the  infection  and  the  fever  in 
the  natural  and  artificial  small-pox  may  nevertheless  depend  on 
its  being  inserted  into  a different  series  of  vessels;  or  to  some  un- 
known effect  of  lunar  periods.  It  is  a subject  of  great  curiosity, 
and  deserves  further  investigation. 


<£laSs  II.  I.  3.  9. 


OF  SENSATION. 


205 


When  the  inoculated  small-pox  is  given  under  all  the  most  fa- 
vourable circumstances,  I believe  iess  than  one  in  a thousand 
miscarry,  which  may  be  ascribed  to  some  unavoidable  accident, 
such,  as  the  patient  having  previously  received  the  infection,  or 
being  about  to  be  ill  of  some  other  disease.  Those  which  have 
lately  miscarried  under  inoculation,  as  far  as  has  come  to  my 
knowledge,  have  been  chiefly  children  at  the  breast;  for  in  these 
the  habit  of  living  in  the  air  has  been  confirmed  by  so  short  a 
time,  that  it  is  much  easier  destroyed,  than  when  these  habits  of 
life  have  been  established  by  more  frequent  repetition.  See  Sect. 
XVlt.  3.  Thus  it  appears  from  the  bills  of  mortality  kept  in  the 
great  cities  of  London,  Paris,  and  Vienna,  that  out  of  every  thou- 
sand children,  above  three  hundred  and  fifty  die  under  two  years 
olu.  (Kirkpatrick  on  Inoculation.)  Whence  a strong  reason 
against  our  hazarding  inoculation  before  that  age  is  passed,  espe- 
cially in  crowded  towns;  except  where  the  vicinity  of  the  natu- 
rai  contagion  renders  it  necessary,  or  the  convenience  of  inocu- 
lating a whole  family  at  a time;  as  it  then  becomes  better  to 
venture  the  less  favourable  circumstances  of  the  age  of  the  pa- 
tient, or  the  chance  of  the  pain  from  toothing,  than  to  risk  the 
infection  in  the  natural  way. 

The  most  favourable  method  consists  in,  first,  for  a week  be- 
fore inoculation,  restraining  the  patients  from  all  kinds  of  fer- 
mented or  spirituous  liquor,  and  from  animal  food;  and  by  giv- 
ing them  from  one  grain  to  three  or  four  of  calomel  every  other 
day  for  three  times.  But  if  the  patients  be  in  any  the  least  dan- 
ger of  taking  the  natural  infection,  the  inoculation  had  better  be 
immediately  performed,  and  this  abstinence  then  begun;  and  twm 
or  three  gentle  purges  with  caiomel  should  be  given,  one  imme- 
diately, and  on  alternate  days.  These  cathartics  should  not  in- 
duce more  than  two  or  three  stools.  I have  seen  tw'O  instances 
of  a confluent  small-pox  in  inoculation  following  a violent  purg- 
ing induced  by  too  large  a dose  of  calomel. 

Secondly,  the  matter  used  for  inoculation  should  be  in  a small 
quantity,  and  warm,  and  fluid.  Hence  it  is  best  when  it  can  be 
■ recently  taken  from  a patient  in  the  disease;  or  otherwise  it  may 
be  diluted  with  part  of  a drop  of  warm  w7ater,  since  its  fluidity 
is  likely  to  occasion  its  immediate  absorption;  and  the  wound 
should  be  made  as  small  and  superficial  as  possible,  as  otherwise 
ulcers  have  been  supposed  sometimes  to  ensue  with  subaxillary 
abscesses.  Add  to  this,  that  the  making  two  punctures  either  on 
the  same  or  one  on  each  arm,  secures  the  success  of  the  opera- 
tion in  respect  to  communicating  the  infection. 

Thirdly,  at  the  time  of  the  fever  or  eruption,  the  application 
of  ccoi  air  to  those  parts  of  the  skin  which  are  too  warm,  or  ap- 


206 


DISEASES 


Class  IT.  1.  3.  9. 


pear  red,  or  are  covered  with  what  is  termed  a rash,  should  be 
used  freely,  as  well  as  during  the  whole  disease.  And  at  the 
same  time,  if  the  feet  or  hands  are  colder  than  natural,  these 
should  be  covered  with  flannel.  See  Class  IV.  2.  2.  10. 

Where  the  matter  used  is  not  procured  quite  fresh,  the  manner 
of  preserving  it  should  be  nicely  attended  to:  as  I have  been  in- 
formed that  a surgeon  procured  some  matter  in  a fluid  state, 
about  a tea-spoonful,  which  had  been  kept  some  time  in  a quill, 
and  afterwards  in  a small  phial,  which  he  carried  sixteen  hours 
in  his  breeches-pocket;  with  this  he  inoculated  many  children, 
most  of  whom  had  not  the  small-pox  in  consequence,  but  were 
affected  with  typhus,  one  of  whom  died.  Whence  it  appears, 
that  the  variolous  matter  had  undergone  by  putrefaction  a decom- 
position, and  that  another  kind  of  contagious  material  had  been 
produced;  which  agrees  with  the  ingenious  observations  of  Dr. 
Jenner,  in  his  treatises  on  the  variolae  vaccinae,  or  cow-pox;  and 
of  Mr.  Kite,  related  in  the  Memoirs  of  the  Medical  Society  of 
London,  Vol.  IV. 

May  not  the  confluent  small-pox  proceed  from  the  contagious 
matter  having  undergone  a partial  putrefaction,  so  as  to  contain 
both  the  variolous  and  the  typhus  contagion?  and  that,  whether 
the  disease  be  taken  naturally  or  by  inoculation?  and  that  hence 
the  confluent  kind  consists  of  the  small-pox,  with  the  fever  com- 
monly termed  putrid?  and  that,  lastly,  as  Dr.  Jenner  observes, 
where  the  small-pox  has  been  said  to  recede,  or  not  to  rise,  the 
disease  has  been  simply  a malignant  or  typhus  fever,  febris  sen- 
sativa  inirrilata,  mistaken  for  the  small-pox? 

Variola  vaccina.  Cow-pox.  Cows  are  liable  to  an  eruption 
on  their  paps  or  udders,  in  some  counties,  as  in  Gloucestershire; 
which  has  occasionally  communicated  to  the  hands  or  arms  of 
those  who  milked  them,  producing  an  ulcer,  and  some  degree  of 
fever:  and  it  had  been  long  observed  by  the  people  of  those  coun- 
ties, that  those  who  had  undergone  this  disease,  which  was  called 
the  cow-pox,  were  not  liable  to  the  small-pox. 

Dr.  Jenner,  an  eminent  physician  in  Gloucestershire,  fortu- 
nately attended  to  this  disease,  found  it  to  be  much  milder  than 
the  small-pox,  and  that  the  fact  was  true,  that  it  secured  ^hose 
who  had  been  infected  with  it  from  afterwards  being  liable  to 
the  variolous  infection.  He  also  observed,  that  the  vaccine-pox 
is  not  infectious,  but  by  careful  inoculation;  and  that  on  this 
account,  it  might  be  inoculated  in  a family,  without  endanger- 
ing others.  A circumstance  of  great  consequence  to  the  public, 
as  the  inoculation  of  the  small-pox  is  known  frequently  to  pro- 
pagate that  disease;  and  also  to  private  families,  when  there 
happens  to  be  a pregnant  woman  in  them,  who  has  not  had  the 


CaassII.  1.  3.  9. 


OF  SENSATION’. 


201 


small-pox:  to  all  whom  in  that  situation  it  is  dangerous,  as  it 
generally  produces  miscarriage,  and  frequently  death.  Dr. 
Cappe,  in  an  ingenious  paper  in  the  York  Herald,  observes,  that 
the  vaccine  disease  is  never  communicated  but  by  contact,  and 
then  only  when  the  matter  lies  on  the  broken  skin;  and  that 
many  women  during  pregnancy  have  passed  through  this  dis- 
ease, and  none  have  suffered  from  it;  and  that  instead  of  being 
peculiarly  dangerous  to  young  infants,  as  the  small-pox  is,  it 
seems  to  be  peculiarly  mild  to  them. 

From  all  these  circumstances  it  maybe  hoped,  that  the  inocu- 
lation of  the  cow-pox  may  become  so  general,  and  performed 
so  early  in  life,  as  totally  to  eradicate  the  small-pox;  by  which 
latter  disease  above  two  thousand  persons  are  shewn  by  Dr. 
Cappe,  by  the  bills  of  mortality,  to  be  annually  destroyed  in  a 
part  of  London  only. 

As  the  cow-pox  is  so  much  less  infectious  than  the  small-pox, 
it  requires  much  more  care  in  the  inoculation  to  give  the  disease 
with  certainty;  whence  it  has  sometimes  happened,  that  a slight 
inflammation  from  the  puncture  of  the  lancet  has  been  mistaken 
by  the  unskilful  for  the  vaccine  disease:  and  I have  heard  of  four 
such  patients  in  this  country,  who  have  afterwards  taken  the 
small-pox.  But  as  Dr.  Woodville  inoculated  a thousand  people 
with  the  small-pox,  who  had  previously  received  the  cow-pox, 
without  one  of  them  taking  the  infection,  there  can  be  no  doubt 
but  that  the  four  patients  above  mentioned  had  not  previously 
undergone  the  vaccine  disease;  and  ought  not  therefore  to  dis- 
credit this  fortunate  and  wonderful  discovery. 

In  the  counties  where  the  cows  are  subject  to  this  disease,  the 
milking  is  performed  principally  by  men-servants;  and  it  is 
there  believed,  as  Dr.  Jenner  mentions,  that  the  disease  was  pre- 
viously given  to  the  paps  of  the  cows  by  the  hands  of  the  men 
who  milked  them,  and  who  had  previously  acquired  the  infec- 
tious matter  from  the  heels  of  horses,  w7hich  discharged  an  acrid 
sanies,  when  they  had  a disease  called  the  grease.  This  may  be 
worth  further  investigation;  as  the  preservation  of  people  from 
the  small- pox,  by  their  having  undergone  the  cow-pox,  is  so  won- 
derful a phenomenon,  so  contrary  to  our  previous  knowledge  of 
any  analogy  between  the  infectious  diseases  of  men  and  quadru- 
peds, that  other  facts  equally  surprising  may  exist.  May  not  the 
small-pox  have  been  originally  acquired  from  the  cow-pox? 
wnich  latter,  having  been  a much  older  disease,  may  by  process 
of  time  have  become  milder  than  the  former;  as  the  small-pox  is 
believed  also  to  have  become  much  milder  than  formerly;  owing 
probably  to  the  incapacity  of  receiving  it,  which  exists  in  those 
who  have  undergone  that  disease,  having  in  process  of  time 


208 


Diseases 


Class  II.  1.  3.  10. 


become  hereditary.  Which  incapacity  of  receiving  a second  time 
the  small-pox  may  be  explained  from  the  general  law  of  anima- 
tion, that  stimuli  greater  than  natural  lose  their  effect  by  habit, 
or  from  their  being  too  violently  or  too  frequently  applied. 

As  the  cow-pox  is  said  to  be  so  favourable  to  infants,  great 
benefit  might  accrue  to  mankind  by  their  early  inoculation, 
which  might  in  time  exterminate  the  small-pox.  This  might 
be  perhaps  effected  by  establishing  a dispensary  in  towns,  and 
even  villages,  and  allowing  a premium  of  a few  shillings  to  every 
one  of  the  poor  who  should  be  thus  inoculated,  as  well  as  their 
daily  sustenance  for  eight  or  ten  days,  that  their  arms  might  be 
inspected  by  a surgeon,  to  ascertain  that  they  underwent  the 
genuine  disease. 

10.  Rubeola  irritata , niorbilli.  The  measles  commence  with 
sneezing,  red  eyes,  dry  hoarse  cough,  and  are  attended  with  sen- 
sitive irritated  fever.  On  the  fourth  day,  or  a little  later,  small 
thick  eruptions  appear,  scarcely  eminent  above  the  skin,  and  af- 
ter three  days,  changing  into  very  small  branny  scales. 

As  the  contagious  material  of  the  small-pox  may  be  supposed 
to  be  diffused  in  the  air  like  a fine  dry  powder,  and  mixing  with 
the  saliva  in  the  mouth  to  infect  the  tonsils  in  its  passage  to  the 
stomach;  so  the  contagious  materia!  of  the  measles  may  be  suppos- 
ed to  be  more  completely  dissolved  in  the  air,  and  thus  to  impart 
its  poison  to  the  membrane  of  the  nostrils,  which  covers  the  sense 
of  smell;  whence  a catarrh  with  sneezing  ushers  in  the  fever; 
the  termination  of  the  nasal  duct  of  the  lachrymal  sac  is  subject 
to  the  same  stimulus  and  inflammation,  and  affects  by  sympathy 
the  lachrymal  glands,  occasioning  a great  flow  of  tears.  See 
Sect.  XVI.  8.  And  the  redness  of  the  eye  and  eyelids  is  pro- 
duced in  consequence  of  the  tears  being  in  so  great  quantity, 
that  the  saline  part  of  them  is  not  entirely  reabsorbed.  See 
Sect.  XXIV.  2.  S. 

The  contagion  of  the  measles,  if  it  be  taken  a sufficient  time 
before  inoculation,  so  that  the  eruption  may  commence  before 
the  variolous  fever  comes  on,  stops  the  progress  of  the  small-pox 
in  the  inoculated  wound,  and  delays  it  till  the  measle-fever  has 
finished  its  career.  See  Sect.  XXXIII.  2.  9. 

The  measles  are  usually  attended  with  inflammatory  fever  with 
strong  pulse,  and  bear  the  lancet  in  every  stage  of  the  disease. 
In  the  early  periods  of  it,  venesection  renders  the  fever  and 
cough  less;  and,  if  any  symptoms  of  peripneumony  occur,  is 
repeatedly  necessary ; and  at  the  decline  of  the  disease,  if  a 
cough  be  left  after  the  eruption  has  ceased,  and  the  subsequent 
branny  scales  are  falling  oil,  venesection  should  be  immediately 
used;  which  prevents  the  danger  of  consumption.  At  this  time 


Class  II.  1.  3.  11. 


OF  SENSATION. 


209 


also  change  of  air  is  of  material  consequence,  and  often  removes 
the  cough  like  a charm,  as  mentioned  in  a similar  situation  at 
the  end  of  the  chin-cough. 

Rubeola  inirritata.  Measles  with  inirritated  fever,  or  with 
weak  pulse,  has  been  spoken  of  by  some  writers.  See  London 
Med.  Observ.  Vol.  IV.  Art.  XI.  It  has  also  been  said  to  have 
been  attended  with  sore  throat.  Edinb.  Essays,  Vol.  V.  Art.  II. 
Could  the  scarlet  fever  have  been  mistaken  for  the  measles?  or 
might  one  of  them  have  succeeded  the  other,  as  in  the  measles 
and  small-pox  mentioned  in  Sect.  XXXIII.- 2.  9.? 

From  what  has  been  said,  it  is  probable  that  inoculation  might 
disarm  the  measles  as  much  as  the  small-pox,  by  preventing  the 
catarrh,  and  frequent  pulmonary  inflammation,  which  attends 
this  disease;  both  of  which  are  probably  the  consequence  of 
the  immediate  application  of  the  contagious  miasmata  to  these 
membranes.  Some  attempts  have  been  made,  but  a difficulty 
seems  to  arise  in  giving  the  disease;  the  blood,  I conjecture, 
would  not  infect,  nor  the  tears;  perhaps  the  mucous  discharge 
from  the  nostrils  might  succeed;  or  a drop  of  warm  water  put 
on  the  eruptions,  and  scraped  off  again  with  the  edge  of  a lan- 
cet; or  if  the  branny  scales  were  collected,  and  moistened  with 
a little  warm  water?  Further  experiments  on  this  subject  would 
be  worthy  the  public  attention . 

11.  Scarlatina  mills.  The  scarlet  fever  exists  with  all  degrees 
of  virulence,  from  a flea-bite  to  the  plague.  The  infectious 
material  of  this  disease,  like  that  of  the  small-pox,  I suppose  to 
be  diffused,  not  dissolved,  in  the  air;  on  which  account  I sus- 
pect that  it  requires  a much  nearer  approach  to  the  sick  for  a 
well  person  to  receive  the  infection,  than  in  the  measles;  the 
contagion  of  which  I believe  to  be  more  volatile,  or  diffusible, 
in  the  atmosphere.  But  as  the  contagious  miasmata  of  small- 
pox and  scarlet  fever  are  supposed  to  be  more  fixed,  they  may 
remain  for  a longer  time  in  clothes  or  furniture;  as  a thread  dip- 
ped in  variolous  matter  has  given  the  disease  by  inoculation  after 
having  been  exposed  many  days  to  the  air,  and  after  having  been 
kept  many  months  in  a phial.  This  also  accounts  for  the  slow  or 
sporadic  progress  of  the  scarlet  fever,  as  it  infects  others  at  but 
a very  small  distance  from  the  sick;  and  does  not  produce  a 
quantity  of  pus-like  matter,  like  the  small-pox,  which  can  ad- 
here to  the  clothes  of  the  attendants,  and  when  dried  is  liable  to 
be  shaken  off  in  the  form  of  powder,  and  thus  propagate  the 
infection. 

This  contagious  powder  of  the  small-pox,  and  of  the  scarlet 
fever,  becomes  mixed  with  saliva  in  the  mouth,  and  is  thus  car- 
ried to  the  tonsils,  the  mucus  of  which  arrests  some  particles  of 

vor.  n.  e e 


210 


DISEASES 


Class  II.  1.  3.  II 


this  deleterious  material;  while  other  parts  of  it  are  carried  into 
the  stomach,  and  are  probably  decomposed  by  the  power  of  di- 
gestion; as  seems  to  happen  to  the  venom  of  the  viper,  when 
taken  into  the  stomach.  Our  perception  of  bad  tastes  in  our 
mouths,  at  the  same  time  that  we  perceive  disagreeable  odours 
to  our  nostrils,  when  we  inhale  very  bad  air,  occasions  us  to  spit 
out  our  saliva;  and  thus,  in  some  instances,  to  preserve  ourselves 
from  infection.  This  has  been  supposed  to  originate  from  the 
sympathy  between  the  organs  of  taste  and  smell;  but  any 
one  who  goes  into  a sick-room  close  shut  up,  or  into  a crowded 
assembly-room,  or  tea-room,  which  is  not  sufficiently  ventilated, 
may  easily  mix  the  bad  air  with  the  saliva  on  his  tongue  so  as  to 
taste  it;  as  I have  myself  frequently  attended  to. 

Hence  it  appears  that  these  heavy  infectious  matters  are  more 
liable  to  mix  with  the  saliva,  and  inflame  the  tonsils,  and  that 
either  before  or  at  the  commencement  of  the  fever  ; and  this  is 
what  generally  happens  in  the  scarlet  fever,  always  I suppose  in 
the  malignant  kind,  and  very  frequently  in  the  mild  kind.  But 
as  this  infection  may  be  taken  by  other  means,  as  by  the  skin, 
it  also  happens  in  the  most  mild  kind,  that  there  is  no  inflamma- 
tion of  the  tonsils  at  all  ; in  the  same  manner  as  there  is  gene- 
rally no  inflammation  of  the  tonsils  in  the  inoculated  small-pox. 

In  the  mild  scarlatina  on  the  fourth  day  of  the  fever  the  face 
swells  a little,  at  the  same  time  a florid  redness  appears  on  vari- 
ous parts  of  the  skin  in  large  blotches,  at  length  coalescing,  aud 
after  three  days  changing  into  branny  scales. 

M.  M.  Cool  air.  Fruit.  Lemonade.  Milk  and  water. 

Scarlatina  maligna.  The  malignant  scarlet  fever  begins  with 
inflamed  tonsils;  which  are  succeeded  by  dark  drab-coloured 
sloughs  from  three  to  five  lines  in  diameter,  flat,  or  beneath  the 
surrounding  surface;  and  which  conceal  beneath  them  spreading 
gangrenous  ulcers.  The  swellings  of  the  tonsils  are  sensible  to 
the  eye  and  touch  externally,  and  have  an  elastic  rather  than  an 
oedematous  feel,  like  parts  in  the  vicinity  of  gangrenes.  The 
pulse  is  very  quick  and  weak,  with  delirium,  and  the  patient 
generally  dies  in  a few  days;  or  if  he  recovers,  it  is  by  slow  de- 
grees, and  attended  with  anasarca. 

M.  M.  A vomit  once.  Wine.  Beer.  Cider.  Opium. 
Bark,  in  small  repeated  doses.  Small  successive  blisters,  if  the 
extremities  are  cooler  than  natural.  Cool  air  on  the  hot  parts 
of  the  skin,  the  cool  extremities  being  at  the  same  time  covered. 
Iced  lemonade.  Broth.  Custards.  Milk.  Jellies.  Bread 
pudding.  Chicken.  Touch  the  ulcers  with  a dry  sponge  to 
absorb  the  contagious  matter,  and  then  with  a sponge  filled  with 
vinegar,  with  or  without  sugar  of  lead  dissolved  in  it,  about  six 


Giass  II.  1.  3.  11. 


OP  SENSATION. 


211 


grains  to  an  ounce;  or  with  a very  little  blue  vitriol  dissolved  in 
it,  as  a grain  to  an  ounce;  but  nothing  so  instantaneously  cor- 
rects the  putrid  smell  of  ulcers  as  a solution  of  alum,  about  half 
an  ounce  to  a pint  of  water,  which  should  be  a little  warmish, 
and  injected  into  the  fauces  gently  by  means  of  a syringe.  These 
should  be  repeated  frequently  in  a day,  if  it  can  be  done  easily, 
and  without  fatigue  to  the  child.  A little  powder  of  bark  taken 
frequently  into  the  mouth,  as  a grain  or  two,  that  it  may  mix 
with  the  saliva,  and  thus  frequently  stimulate  the  dying  ton- 
sils. Could  a ivarm  bath  made  of  decoction  of  bark,  or  a cold 
alluviation  with  it,  be  of  service?  Could  oxygene  gas  mixed  with 
common  air  stimulate  the  languid  system?  Small  electric  shocks 
through  the  tonsils  every  hour?  ether  frequently  applied  exter- 
nally to  the  swelled  tonsils? 

As  this  disease  is  attended  with  the  greatest  degree  of  debility, 
and  as  stimulant  medicines,  if  given  in  quantity,  so  as  to  produce 
more  than  natural  warmth,  contribute  to  expend  the  already  too 
much  exhausted  sensorial  power;  it  appears,  that  there  is  nothing 
so  necessary  to  be  nicely  attended  to  as  to  prevent  any  unneces- 
sary motions  of  the  system;  this  is  best  accomplished  by  the  ap- 
plication of  cold  to  those  parts  of  the  skin,  which  are  in  the  least 
too  hot.  Dr.  Mosman,  of  Bradford,  directed  a boy  of  eight  years 
of  age,  who  was  very  hot,  and  covered  with  the  scarlet  eruption, 
to  be  taken  naked  out  of  bed,  and  moistened  his  skin  all  over 
with  cold  vinegar,  by  means  of  a sponge,  with  great  and  good 
event.  It  is  probable  that  cold  vinegar  might  diminish  the  in- 
flammation and  consequent  heat  of  the  skin  more  effectually  than 
cold  water,  as  its  application  to  the  lips  renders  them  pale,  pro- 
bably by  stimulating  the  absorbent  extremities  of  the  veins  into 
greater  action.  Annals  of  Medicine,  Yol.  IV.  1799.  Secondly, 
that  the  exhibition  of  the  bark  in  such  quantity  as  not  to  oppress 
the  stomach  and  injure  digestion,  is  next  to  be  attended  to,  as 
not  being  liable  to  increase  the  actions  of  the  system  beyond 
their  natural  quantity;  and  that  opium  and  wine  should  be  given 
with  the  greatest  caution,  in  very  small  repeated  quantity,  and 
so  managed  as  to  prevent,  if  possible,  the  cold  fits  of  fever; 
which  probably  occur  twice  in  25  hours,  obeying  the  lunations 
like  the  tides,  as  mentioned  in  Sect.  XXXII.  6.  that  is,  I sup- 
pose, the  cold  periods,  and  consequent  exacerbations  of  fever,  in 
this  malignant  scarlatina,  occur  twice  in  a lunar  day;  which  is 
about  ten  minutes  less  than  25  hours;  so  that  if  the  commence- 
ment of  one  cold  fit  be  marked,  the  commencement  of  the  next 
may  be  expected  (if  not  disturbed  by  the  exhibition  of  wine,  or 
opium,  or  the  application  of  blisters)  to  occur  in  about  twelve 


212 


DISEASES 


Class  II.  1.  o.  12. 


hours  and  a half  from  the  commencement  of  the  former;  or  if  not 
prevented  by  large  doses  of  the  bark. 

No  one  could  do  an  act  more  beneficial  to  society,  or  glorious 
to  himself,  than  by  teaching  mankind  how  to  inoculate  this  fatal 
disease,  and  thus  to  deprive  it  of  its  malignity.  Matter  might 
be  taken  from  the  ulcers  in  the  throat,  which  would  probably 
convey  the  contagion;  or  warm  water  might  be  put  on  the  erup- 
tion, and  scraped  off  again  by  the  edge  of  a lancet.  These  ex- 
periments could  be  attended  with  no  danger,  and  should  be  tried 
for  the  public  benefit,  and  the  honour  of  medical  science. 

Dr.  Harwood,  professor  of  anatomy,  at  Cambridge,  favoured 

me  with  the  following  curious  case  of  this  infection:  Mr.  N 

had  a violent  delirium  in  the  scarlet  fever,  with  the  skin  cracked 
in  many  places,  exuding  an  ichorous  matter;  he  was  attended 
by  a poor  man  who  had  recently  cut  his  hand  with  a glass  bottle, 
and  in  the  struggle  of  confining  him  to  bed  his  wounded  hand 
was  frequently  applied  to  the  patient’s  body.  This  happened 
on  the  Friday  night;  his  hand  was  inflamed  and  the  arm  swelled 
the  next  day;  on  the  Monday  following  he  was  seized  with  the 
same  fever,  and  died  on  the  Wednesday  morning  after.  This 
would  seem  to  shew,  as  far  as  a single  case  can  be  relied  on,  that 
the  scarlet  fever  may  be  communicated,  like  the  small-pox,  by 
inoculation,  and  probably  with  similar  success,  if  the  matter  be 
diluted  with  warm  water,  used  in  small  quantity,  and  by  super- 
ficial incisions  only,  through  the  cuticle. 

12.  Miliaria.  Miliary  fever.  An  eruption  produced  by  the 
warmth,  and  more  particularly  by  the  stimulus,  of  the  points  of 
the  wool  in  flannel  or  blankets  applied  to  the  skin,  has  been  fre- 
quently observed;  which,  by  cool  dress,  and  bed-clothes  without 
flannel,  has  soon  ceased.  See  Class  I.  1.  2.  3.  This,  which 
may  be  called  miliaria  sudatoria,  has  been  confounded  with  other 
miliary  fevers,  and  has  made  the  existence  of  the  latter  doubted. 
Two  kinds  of  eruptions  I have  seen  formerly  attended  with  fever, 
but  did  not  sufficiently  mark  their  progress,  which  I conceived 
to  be  miliary  eruptions,  one  with  arterial  strength,  or  with  sen- 
sitive irritated  fever,  and  the  other  with  arterial  debility,  or  with 
sensitive  inirritated  fever. 

In  the  former  of  these,  or  miliaria  irritata , the  eruptions  were 
distinct  and  larger  than  the  small-pox,  and  the  fever  was  not  sub- 
dued without  two  or  three  venesections,  and  repeated  cathartics 
with  calomel. 

The  latter,  or  miliaria  inirritata , was  attended  with  great  ar- 
terial debility;  and  during  the  course  of  the  fever  pellucid  points 
appeared  within  the  skin,  particularly  on  the  soft  parts  of  the 
fingers.  And,  in  one  patient,  whom  I esteemed  near  her  eud. 


Class  II.  1.  3.  13. 


OF  SENSATION. 


213 


I well  recollect  to  have  observed  round  pellucid  globules,  like 
what  are  often  seen  on  vines  in  hot-houses,  no  larger  than  the 
smallest  pins’  heads,  adhere  to  her  neck  and  bosom;  which  were 
hard  to  the  touch,  but  were  easily  rubbed  off.  These  diseases,  if 
they  are  allied,  do  not  differ  more  than  the  kinds  of  small-pox;  but 
require  many  further  observations. 

The  eruption  so  often  seen  on  children  in  the  cradle,  and  call- 
ed by  the  nurses  red-gum,  and  which  is  attended  with  some  de- 
gree of  fever,  I suspect  to  be  produced  by  too  great  warmth,  and 
the  contact  of  flannel  next  their  tender  skins,  like  the  miliaria 
sudatoria;  and  like  that  requires  cool  air,  cool  clothes,  and  linen 
next  their  skin. 

13.  Pestis.  The  plague,  like  other  diseases  of  this  class,  seems 
to  be  sometimes  mild,  and  sometimes  malignant;  according  to 
the  testimony  of  different  writers.  It  is  said  to  be  attended  with 
inflammation,  with  the  greatest  arterial  debility,  and  to  be  very 
contagious,  attended  at  an  uncertain  time  of  the  fever  with  bu- 
boes and  carbuncles.  Some  authors  affirm,  that  the  contagion 
of  the  plague  may  be  repeatedly  received,  so  as  to  produce  the 
disease;  but  as  this  is  contrary  to  the  general  analogy  of  all  con- 
tagious diseases,  which  are  attended  with  fever,  and  which  cure 
themselves  spontaneously;  there  is  reason  to  suspect,  that,  where 
it  has  been  supposed  to  have  been  repeatedly  received,  some- 
other  fever  with  arterial  debility  has  been  mistaken  for  it,  as  has 
probably  universally  been  the  case,  when  the  small-pox  has  been 
said  to  have  been  twice  experienced. 

M.  M.  Venesection  has  been  recommended  by  some  writers 
on  the  first  day,  where  the  inflammation  wras  supposed  to  be  at- 
tended with  sufficient  arterial  strength,  which  might  perhaps  some- 
times happen,  as  the  bubo  seems  to  be  a suppuration;  but  the 
carbuncle,  or  anthrax,  is  a gangrene  of  the  part,  and  shews  the 
greatest  debility  of  circulation.  Whence  all  the  means  before 
enumerated  in  this  genus  of  diseases  to  support  the  powers  of  life 
are  to  be  administered.  Currents  of  cold  air,  cold  water,  ice, 
externally  on  the  hot  parts  of  the  skin. 

The  methods  of  preventing  the  spreading  of  this  disease  have 
been  much  canvassed,  and  seem  to  consist  in  preventing  all  con- 
gregations of  the  people,  as  in  churches,  or  play-houses;  and  to 
remove  the  sick  into  tents,  on  some  airy  common,  by  the  side  of 
a river,  and  supply  them  with  fresh  food,  both  animal  and  vege- 
table; with  beer  and  wine,  in  proper  quantities;  and  to  encou- 
rage those  who  can,  daily  to  wash  both  their  clothes  and  them- 
selves. 

The  pestis  vaccina , or  disease  amongst  the  cows,  which  afflict- 
ed this  island  about  half  a century  ago,  seems  to  have  been  a 


214 


DISEASES 


Class  H.  1.  3.  14. 


contagious  fever,  with  great  arterial  debility;  as  in  some  of  them, 
in  the  latter  stage  of  the  disease,  an  emphysema  could  often  be 
felt  in  some  parts,  which  evinced  a considerable  progress  of  gan- 
grene beneath  the  skin.  In  the  sensitive  inirritated  fevers  of 
these  animals,  I suppose  about  sixty  grains  of  opium,  with  two 
ounces  of  extract  of  oak-bark,  every  six  hours,  would  supply 
them  with  an  efficacious  medicine;  to  which  might  be  auded 
thirty  grains  of  vitriol  of  iron,  if  any  tendency  to  bloody  urine 
should  appear,  to  which  this  animal  is  liable.  The  method  of 
preventing  the  infection  from  spreading,  if  it  should  ever  again 
gain  access  to  this  island,  would  be  immediately  to  obtain  an  or- 
der  from  government  to  prevent  any  cattle  from  being  removed, 
which  were  found  within  five  miles  of  the  place  supposed  to  be 
infected,  for  a few  days;  till  the  certainty  of  the  existence  of 
the  pestilence  could  be  ascertained,  by  a committee  of  medical 
people.  As  soon  as  this  was  ascertained,  all  the  cattle  within 
five  miles  of  the  place  should  be  immediately  slaughtered,  and 
consumed  w'ithin  the  circumscribed  district;  and  their  hides  put 
into  lime-water,  before  proper  inspectors. 

14.  Pemphigus  is  a contagious  disease,  attended  with  blad- 
dery eruptions,  appearing  on  the  second  or  third  day,  as  large  as 
filberts,  which  remain  many  days,  and  then  effuse  a thin  ichor. 
It  seems  to  be  either  of  a mild  kind,  with  sensitive  fever  only,  of 
which  I have  seen  two  instances;  or  with  irritated,  or  with  in- 
irritated  fever;  as  appears  from  the  observations  of  M.  Salabert. 
See  Medical  Comment.  By  Dr.  Duncan,  Decad.  II.  Vol.  VI. 

15.  Varicella.  Chicken-pox  is  accompanied  with  sensitive 
fever,  pustules  break  out  after  a mild  fever,  like  the  small-pox, 
seldom  suppurate,  and  generally  terminate  in  scales  without  scars. 
I once  saw  a lady  who  miscarried  during  this  disease,  though  all 
her  children  had  it  as  slightly  as  usual.  It  sometimes  leaves 
scars  or  marks  on  the  skin.  This  disease  has  been  mistaken  for 
the  small- pox,  and  inoculated  for  it ; and  then  the  small-pox  has 
been  supposed  to  happen  tw'ice  to  the  same  person.  See  Trans, 
of  the  College,  London.  It  is  probable  that  the  pemphigus  and 
urticaria,  as  well  as  this  disease,  have  formerly  been  diseases  of 
more  danger;  which  the  habit  of  innumerable  generations  may 
have  rendered  mild,  and  will  in  process  of  time  annihilate.  In 
the  same  manner  as  the  small-pox,  venereal  disease,  and  rickets, 
seem  to  become  milder  or  less  in  quantity  every  half  century. 
While  at  the  same  time,  it  is  not  improbable,  that  other  new  dis- 
eases may  arise;  and,  for  a season,  thin  mankind. 

16.  Urticaria.  Nettle  rash  begins  with  mild  sensitive  fever, 
which  is  sometimes  scarcely  perceptible.  Hence  this  eruption 
has  been  thought  of  two  sorts,  one  with  and  the  other  without 


Class  II.  1.3. 17. 


OP  SENSATION. 


215 


fever.  On  the  second  day  red  spots,  like  parts  stung  with  net- 
tles, are  seen;  which  almost  vanish  during  the  day,  and  recur  in 
the  evening  with  the  fever,  succeeded  in  a few  days  by  very 
minute  scales.  See  Trans,  of  the  College,  London. 

17.  Aphtha.  Thrush.  It  has  been  doubted,  whether  aphtha 
or  thrush,  which  consists  of  ulcers  in  the  mouth,  should  be  enu- 
merated amongst  febrile  diseases;  and  whether  these  ulcers  are 
always  symptomatic,  or  the  consequence  rather  than  the  cause  of 
the  fevers  which  attend  them.  The  tongue  becomes  rather 
swelled;  its  colour  and  that  of  the  fauces  purplish;  sloughs  or 
ulcers  appear  first  on  the  throat  and  edges  of  the  tongue,  and  at 
length  over  the  whole  mouth.  These  sloughs  are  whitish,  some- 
times distinct,  often  coalescing,  and  remain  an  uncertain  time. 
Cullen.  I shall  concisely  mention  four  cases  of  aphtha,  but  do 
not  pretend  to  determine  whether  they  were  all  of  them  symp- 
tomatic or  original  diseases. 

Aphtha  sensitiva.  A lady  during  pregnancy  was  frequently 
seized  wfith  ulcers  on  her  tongue  and  cheeks,  or  other  parts  of  the 
mouth,  without  much  apparent  fever;  which  continued  two  or 
three  weeks,  and  returned  almost  every  month.  The  thrush  in 
the  mouths  of  young  children  seems  to  be  a similar  disease.  These 
ulcers  resemble  those  produced  in  the  sea-scurvy,  and  have  pro- 
bably for  their  cause  an  increased  action  of  the  secerning  system 
from  increased  sensation,  with  a decreased  action  of  the  absorbent 
system  from  decreased  irritation.  See  Class  I.  2.  1.  14. 

M.  M.  Solutions  of  alum,  of  blue  vitriol.  Powder  of  bark 
taken  frequently  into  the  mouth  in  very  small  quantity.  See 
Class  II.  1.  3.  1. 

Aphtha  irritata.  Inflammatory  aphtha.  A case  of  this  kind 
is  related  under  the  title  of  suppurative  rheumatism.  Class  IV, 
2.  1.  16. 

Aphtha  inirritata.  Sloughs  or  ulcers  of  the  mouth,  attended 
with  sensitive  fever  with  great  arterial  debility.  They  seem  to 
spread  downwards  from  the  throat  into  the  stomach,  and  probably 
through  the  whole  intestinal  canal,  beginning  their  course  with 
cardialgia,  and  terminating  it  with  tenesmus;  and  might  perhaps 
be  called  an  erysipelas  of  this  mucous  membrane. 

M.  M.  Cool  air.  A small  blister  on  the  back.  Bark.  Wine. 
Opium  in  small  repeated  quantities.  Soap  neutralizes  the  gastric 
acid  without  effervescence,  and  thus  relieves  the  pain  of  cardial- 
gia, wkere  the  stomach  is  affected.  Milk  also  destroys  a part  of 
this  acid.  Infusion  of  sage-leaves  two  ounces,  almond-soap  from 
five  grains  to  ten,  with  sugar  and  cream,  is  generally  both  agree- 
able and  useful  to  these  patients.  See  I.  2.4.  5. 

Where  the  stomach  may  be  snpposed  to  be  excoriated  by  poi- 


216 


DISEASES 


Class  II.  1.  3.  18. 


sons  containing  acid,  as  sublimate  of  mercury  or  arsenic;  or  if 
it  be  otherwise  inflamed,  or  very  sensible  to  the  stimulus  of  the 
gastric  acid;  or  where  it  abounds  with  acid  of  any  kind,  as  in 
cardialgia;  the  exhibition  of  soap  is  perhaps  a preferable  manner 
of  giving  alkali  than  any  other,  as  it  decomposes  in  the  stomach 
without  effervescence;  while  the  caustic  alkali  is  too  acrid  to  be 
administered  in  such  cases,  and  the  mild  alkali  produces  carbonic 
gas.  If  a drop  of  acid  of  vitriol  be  put  on  cap-paper,  it  will  be 
long  before  it  destroys  the  paper;  but  if  a drop  of  mild  alkali  be 
added,  a sudden  effervescence  arises,  and  the  paper  is  instantly 
destroyed  by  the  escape  of  the  fixed  air;  in  the  same  manner  as 
lumps  of  solid  lime  are  broken  into  powder  by  the  escape  of  the 
steam  produced  from  the  water,  which  is  poured  on  them.  This 
shews  why  a succession  of  acid  and  of  alkaline  caustics  sooner 
destroys  a part,  than  either  of  them  applied  separately. 

18.  Dysenterici.  Bloody-flux  is  attended  with  sensitive  fever, 
generally  with  arterial  debility;  with  frequent  mucous  or  bloody 
stools,  which  contain  contagious  matter  produced  by  the  mem- 
branes of  the  intestines;  the  alimentary  excrement  being  never- 
theless retained;  with  griping  pains,  and  tenesmus. 

Linnaeus  observed  microscopic  animals  in  the  stools  of  dysen- 
teric patients,  and  concluded  from  thence  that  they  were  the 
cause  of  the  disease;  in  the  same  manner  the  animalcula,  seen 
by  microscopes,  in  the  pustules  of  the  itch,  have  been  supposed 
to  be  the  cause  of  those  eruptions.  See  Article  IV.  2.  1.  3. 
These  animalcula  ore  nevertheless  seen  in  almost  all  animal 
fluids  which  have  for  a time  stagnated;  as  in  the  semen,  and  in 
all  liquid  evacuations  from  the  intestines,  as  asserted  by  Buffon; 
who  esteems  them  to  be  organized  beings,  though  not  perfect 
animals,  in  his  ingenious  treatise  on  generation.  Histoire  Na- 
turelle. 

M.  M.  Emetics.  Antimouials.  Peruvian  bark.  Opium  and 
calomel,  of  each  a grain  every  night.  Bolus  armeniae.  Earth  of 
alum.  Chalk.  Calcined  hartshorn.  Mucilage.  Bees’  wax 
mixed  with  yolk  of  egg.  Cerated  glass  of  antimony.  M arm 
bath.  Flannel  clothing  next  to  the  skin.  Large  clysters  with 
opium.  With  ipecacuanha,  with  smoke  of  tobacco."  Two  dy- 
senteric patients  in  the  same  ward,  of  the  infirmary  at  Edinburgh, 
quarrelled,  and  whipped  each  other  with  horsewhips  a long  time, 
and  were  both  much  better  after  it,  owing  perhaps  to  the  exertion 
of  so  much  of  the  sensorial  power  of  volition;  which,  like  real 
insanity,  added  excitement  to  the  whole  system. 

The  prevention  of  this  contagion  must  consist  principally  in 
ventilation  and  cleanliness;  hence  the  patients  should  be  re- 
moved into  cottages  distant  from  each  other,  or  into  tents;  and 


Glass  II.  1.  3.  19. 


OP  SENSATION, 


2 11 


their  feces  buried  as  soon  as  may  be;  or  conveyed  into  a running- 
stream;  and  themselves  should  be  washed  with  cold  or  warm 
water  after  every  evacuation.  For  the  contagious  matter  consists 
in  the  mucous  or  purulent  discharge  from  the  membrane  which 
lines  the  intestines;  and  not  from  the  febrile  perspiration,  or 
breath  of  the  patients.  For  the  fever  is  only  the  consequence 
and  not  the  cause  of  contagion;  as  appears  from  Genus  the 
Fifth  of  this  Order,  where  contagion  exists  without  fever. 

19.  Gastritis  superficial is.  Superficial  inflammation  of  the 

stomach.  An  erysipelatous  inflammation  of  the  stomach  is  men- 
tioned by  Dr.  Cullen  from  his  own  observations;  which  is  dis- 
tinguished from  the  inflammatory  gastritis  by  less  pain  and  fever, 
and  by  an  erysipelatous  redness  about  the  fauces.  Does  this 
disease  belong  to  aphtha? 

20.  Enteritis  superficialis.  Superficial  inflammation  of  the 
bowels  is  also  mentioned  by  Dr.  Cullen,  from  his  own  observa- 
tion, under  the  name  of  enteritis  erythematica;  and  is  said  to 
be  attended  with  less  pain  and  fever,  without  vomiting,  and  with 
diarrhoea.  May  not  this  disease  be  referred  to  aphtha,  or  to 
dysentery? 


218 


DISEASES 


Class  11.  1.  4.  1. 


ORDO  I. 

Increased  Sensation. 

GENUS  IV. 

With  the  production  of  new  Vessels  by  internal  Membranes  o> 
Glands , without  Fever. 

Where  inflammation  is  produced  in  a small  part,  which  has 
not  great  natural  sensibility,  the  additional  sensation  does  not 
produce  an  increased  action  of  the  arterial  system  ; that  is,  the 
associated  motions  which  are  employed  in  the  circulation  of  the 
blood  (those  for  instance  of  the  heart,  arteries,  glands,  capillaries, 
and  their  correspondent  veins)  are  not  thrown  into  increased  ac- 
tion bv  so  small  an  addition  of  the  sensorial  power  of  sensation. 
But  when  parts  which  naturally  possess  more  sensibility  become 
inflamed,  the  quantity  of  the  sensorial  power  of  sensation  becomes 
so  much  increased,  as  to  affect  the  associated  motions  belonging 
to  the  circulation,  occasioning  them  to  proceed  with  greater  fre- 
quency; that  is,  a fever  is  induced.  This  is  well  exemplified 
in  the  internal  and  superficial  paronychia;  one  of  which  is  at- 
tended with  great  pain  and  fever,  and  the  other  with  little  pain 
and  no  fever.  See  Class  II.  1.2.  19.  and  II.  1.  4.  5. 

From  hence  it  appears,  that  the  sensitive  fever  is  an  accident- 
al consequence  of  the  topical  phlegmon,  or  inflammation,  and 
not  a cause  of  it;  that  it  is  often  injurious,  but  never  salutary; 
and  should  therefore  always  be  extinguished,  as  soon  as  may  be, 
either  by  the  lancet  and  cathartics,  and  diluents,  and  cold  air, 
when  it  is  of  the  irritated  kind;  or  by  the  bark,  opium,  cool  air, 
and  nutrientia,  when  it  is  of  the  inirritated  kind. 

SPECIES. 

1.  Ophthalmia  superficialis.  As  the  membranes,  which  cover 
the  eye,  are  excluded  from  the  air  about  one  third  part  of  the 
twenty-four  hours,  and  are  moistened  by  perpetual  nictitation 
during  the  other  sixteen,  they  may  be  considered  as  internal 
membranes;  and  from  the  analogy  of  their  inflammation  to 
that  of  other  internal  membranes,  it  is  arranged  under  this  ge- 
nus; whilst  the  tonsillitis  is  esteemed  an  inflammation  of  an  ex- 
ternal membrane,  because  currents  of  air  are  perpetually  passing 
both  day  and  night  over  the  fauces. 

The  superficial  ophthalmy  has  generally  been  esteemed  a 


Ciass  n.  1.  4. 1.  OF  SENSATION.  ' 219 

symptom  of  scrofula,  when  it  recurs  frequently  in  young  per- 
sons; but  is  probably  only  a concomitant  of  that  disease,  as  a 
symptom  of  general  debility;  ramifications  of  new  red  vessels, 
and  of  enlarged  old  ones,  are  spread  over  the  white  part  of  the 
eye;  and  it  is  attended  with  less  heat,  less  pain,  and  less  intole- 
rance of  light  than  the  ophthalmia  interna,  described  in  Class  II. 
1.  2.  2.  It  occurs  in  those  of  feeble  circulation,  especially  chil- 
dren of  a scrofulous  tendency,  and  seems  to  arise  from  a pre- 
vious torpor  of  the  vessels  of  the  tunica  albuginea  from  their  being- 
exposed  to  cold  air;  and  from  this  torpor  being  more  liable  to 
occur  in  habits,  which  are  naturally  inirritable;  and  therefore 
more  readily  fall  into  quiescence  by  a smaller  deduction  of  the 
stimulus  of  heat,  than  would  affect  stronger  or  more  irritable 
habits;  the  consequence  of  this  torpor  is  increased  action,'  which 
produces  pain  in  the  eye,  and  that  induces  inflammation  by  the 
acquisition  of  the  additional  sensorial  power  of  sensation. 

Ophthalmia  lymphatica  is  a kind  of  anasarca  of  the  tunica  ad- 
nata; in  this  the  vessels  over  the  sclerotica,  or  white  part  of  the 
eye,  rise  considerably  above  the  cornea,  which  they  surround,  are 
less  red  than  in  the  ophthalmia  superficialis,  and  appear  to  be 
swelled  by  an  accumulation  of  lymph  rather  than  of  blood;  it 
is  probably  owing  to  tire  temporary  obstruction  of  a branch  of  the 
lymphatic  system. 

M.  M.  If  the  pain  be  great,  venesection  by  leeches  on  the 
temple,  or  cutting  the  temporal  artery,  and  one  purge  with  three 
or  four  grains  of  calomel  should  be  premised.  Then  the  Peru- 
vian bark  twice  a day.  Opium  from  a quarter  to  half  a grain 
twice  a day  for  some  weeks.  Bathe  the  eye  frequently  with 
cold  water  alone,  or  with  cold  water  to  a pint  of  which  is  added 
half  an  ounce  of  salt.  White  vitriol,  six  grains  dissolved  in  one 
ounce  of  water;  a drop  or  two  to  be  put  between  the  eyelids 
twice  a day.  Take  very  small  electric  sparks  from  the  eyes  every 
day  for  a fortnight.  Bathe  the  whole  head  with  salt  and  water 
made  warm,  every  night  for  some  months.  Send  such  children 
to  a school  near  the  sea,  for  the  convenience  of  sea-bathing,  for 
many  months,  annually;  such  schools  are  to  be  found  in  or  near 
Liverpool. 

When  a child  is  afflicted  with  an  inflamed  eye  of  this  kind, 
he  should  always  sit  with  his  back  to  the  window  or  candle; 
but  it  is  generally  not  necessary  to  cover  it,  or  if  the  uneas  , sen- 
sation of  light  makes  this  proper,  the  cover  should  stand  off  from 
the  eye,  so  as  not  much  to  exclude  the  cool  air  from  it.  As 
covering  an  eye  unnecessarily  is  liable  to  make  that  eye  weaker 
than  the  other,  from  its  not  being  sufficiently  used,  and  thence 
to  produce  a squinting  for  ever^afterwards. 


220 


DISEASES 


Ciass  IT.  1.  4.2. 


Nevertheless,  when  the  pain  is  great,  a poultice  must  be  ap- 
plied to  keep  the  eyes  moist,  or  a piece  of  oiled  silk  bound  lightly 
over  (hem.  Or  thus,  boil  an  egg  till  it  is  hard,  cut  it  longitudi- 
nally into  two  hemispheres,  take  out  the  yolk,  sew  the  backs  of 
the  two  hollow  hemispheres  of  the  white  to  a ribbon,  and  bind 
them  over  the  eyes  every  night  on  going  to  bed;  which,  if  nicely 
fitted  on,  will  keep  the  eyes  moist  without  any  disagreeable  pres- 
sure. See  Class  I 1.  3.  14. 

Ophthalmia  equina.  An  inflammation  of  this  kind  is  liable  to 
affect  the  eyes  of  horses;  one  cause  of  which  is  owing  to  a silly 
custom  of  cutting  the  hair  out  of  horses’  ears;  by  which  they 
are  not  only  liable  to  take  cold  at  the  ear,  but  grass-seeds  are  liable 
to  fall  into  their  ears  from  the  high  racks  in  stables;  and  in  both 
cases  the  eye  becomes  inflamed  by  sympathy.  I once  directed 
the  temporal  artery  of  a horse  to  be  opened,  who  had  frequent  re- 
turns of  an  inflamed  eye;  and  I believed  it  was  of  essential  ser- 
vice to  him;  it  is  probable  that  the  artery  was  afterwards  con- 
tracted in  the  wounded  part,  and  that  thence  less  blood  was  derived 
to  the  eye:  the  haemorrhage  was  stopped  by  two  persons  alter- 
nately keeping  their  fingers  on  the  orifice,  and  afterwards  by  a long 
bandage  of  broad  tape. 

2.  Pterigion.  Eye-wing.  A spot  of  inflammation  sometimes 
begins  on  the  inside  of  the  lower  eye-lid,  or  on  the  tunica  albu- 
ginea, and  spreads  an  intertexture  of  red  vessels  from  it,  as  from 
a centre,  which  extend  on  the  white  part  of  the  eye,  and  have  the 
appearance  of  the  wing  of  a fly,  from  whence  its  name. 

M.  M.  Cut  the  ramifications  of  vessels  again  and  again,  with 
the  point  of  a lancet,  close  to  the  centre  of  inflammation.  Touch 
them  repeatedly  with  lunar  caustic.  See  Home  on  the  Urethra. 
Page  101. 

Mr.  Hadley  of  Derby  procured  an  ingenious  instrument  to  be 
made  to  cut  the  vessels,  which  had  spread  their  numerous 
branches  over  an  opaque  cornea,  after  a violent  inflammation; 
by  which  they  were  repeatedly  divided,  with  little  pain  to  the 
patient,  as  there  was  no  necessity  to  hold  them  by  a forceps.  The 
instrument  was  in  the  form  of  a corn-sickle,  or  the  early  crescent 
of  the  new  moon,  about  an  inch  in  length,  the  inner  edge  of  the 
curve  was  sharp,  and  the  point  fine;  the  back  was  rounded  and 
smooth,  and  the  other  end  fixed  in  an  ivory  handle.  The  point  of 
this  was  suddenly  introduced  under  the  branches  of  the  new  ves- 
sels, which  were  thus  cut  upwards,  and  there  was  no  occasion  to 
hold  the  eye,  or  the  trunks  of  the  vessels. 

3.  Tarsitis  palpebrarum.  Inflammation  of  the  edges  of  the 
eyelids.  This  is  a disease  of  the  glands,  which  produce  the  hairs 
of  the  eyelashes,  and  is  frequently  the  cause  of  their  falling  off. 


Class  II.  1.  4.  4. 


OP  SENSATION. 


221 


After  this  inflammation  a hard  scar-like  ridge  is  left  on  the  edge 
of  the  eyelid,  which  scratches  and  inflames  the  eyeball,  and  be- 
comes a very  troublesome  disease. 

The  Turkish  ladies  are  said  to  colour  the  edge  of  the  eyelash 
with  crude  antimony  in  very  fine  powder,  which  not  only  gives 
lustre  to  the  eye,  as  a diamond  set  on  a black  soil,  but  may  pre- 
vent extraneous  light  from  being  reflected  from  these  edges  into 
the  eye,  and  thus  serve  the  purpose  of  the  black  feathers  about 
the  eyes  of  swans,  described  in  Sect.  XXXIX.  5.  1.  and  may 
also  prevent  the  edges  of  the  eyelids  from  being  inflamed  by  the 
frequent  stimulus  of  tears  on  them.  Black  lead  in  fine  powder 
might  be  better  for  all  these  purposes  than  antimony,  and  might 
be  put  on  with  a camel’s  hair  brush. 

M.  M.  Mercurial  ointment  smeared  at  night  on  the  edges 
of  the  eyelids.  Burnt  alum  sixty  grains,  hog’s  grease  half  an 
ounce,  well  rubbed  into  an  ointment  to  be  smeared  on  them  in 
the  night.  Cold  water  frequently  in  the  day.  See  Class  II. 
1.1.8. 

4.  Hordeolum.  Stye.  This  inflammation  begins  either  on 
or  near  the  edges  of  the  eyelids,  or  in  the  loose  skin  of  them,  and 
is  sometimes  very  slow  either  in  coming  to  suppuration  or  in  dis- 
persing. The  skin  beneath  the  lower  eyelid  is  the  most  fre- 
quent seat  of  this  tumour,  which  sometimes  never  suppurates  at 
all,  but  becomes  an  encysted  tumour:  for  as  this  skin  is  very  loose 
for  the  purpose  of  admitting  great  motion  to  the  eyelid,  the  ab- 
sorbent power  of  the  veins  seems  particularly  weak  in  this  part; 
whence  when  any  person  is  weakened  by  fatigue  or  otherwise,  a 
darker  shade  of  colour  is  seen  beneath  the  eyes;  which  is  owing 
to  a less  energetic  action  of  the  absorbent  terminations  of  the 
veins,  whence  the  currents  of  dark  or  venous  blood  are  delayed 
in  them.  This  dark  shade  beneath  the  eyes,  when  it  is  perma- 
nent, is  a symptom  of  habitual  debility,  or  inirritability  of  the  cir- 
culating system.  See  Class  I.  2.  2.  2. 

M.  M.  Smear  the  tumours  with  mercurial  ointment,  moisten 
them  frequently  with  ether.  To  promote  their  suppuration  they 
may  be  wounded  with  a lancet,  or  slit  down  the  middle,  or  they 
may  be  cut  out.  A caustic  leaves  a large  scar. 

5.  Paronychia  superficialis.  Whitlow.  An  inflammation 
about  the  roots  of  the  nail  beneath  the  skin,  which  suppurates 
without  fever,  and  sometimes  destroys  the  nail;  which  is,  how- 
ever, gradually  reproduced.  This  kind  of  abscess,  though  not 
itself  dangerous,  has  given  opportunity  for  the  inoculation  of 
venereal  matter  in  the  hands  of  accoucheurs,  and  of  putrid  mat- 
ter lrom  (he  dissection  of  diseased  bodies;  and  has  thus  been  the 
cause  of  disease  and  death.  When  putrid  matter  has  been 


222 


DISEASES 


Class  II.  1.  4.  6 


thus  absorbed  from,  a dead  body,  a livid  line  from  the  finger  to  the 
swelled  gland  in  the  axilla  is  said  to  be  visible;  which  shews  the 
inflammation  of  the  absorbent  vessel  along  its  whole  course  to  the 
lymphatic  gland;  and  death  has  generally  been  the  consequence. 

M.  M.  In  the  common  paronychia  a poultice  is  generally  suf- 
ficient. In  the  absorption  of  putrid  matter  rub  the  whole  hand 
and  arm  with  mercurial  ointment  three  or  four  times  a day,  or 
perpetually.  Could  the  swelled  axillary  gland  be  exsected?  In 
the  absorption  of  venereal  matter  the  usual  methods  of  cure  in 
syphilis  must  be  administered,  as  in  Class  II.  1.  5.  1. 

6.  Gutta  rosea.  The  rosy  drop  on  the  face  is  of  three  kinds. 
First,  the  gutta  rosea  hepatica,  or  the  red  pimples  on  the  faces  of 
drunkards,  which  are  probably  a kind  of  crisis,  or  vicarious  in- 
flammation, which  succeeds  or  prevents,  a torpor  of  the  mem- 
branes of  the  liver.  This  and  the  succeeding  species  properly  be- 
long to  Class  IV.  1.  2.  14. 

Secondly,  the  pimpled  face,  in  consequence  of  drinking  cold 
water,  or  eating  cold  turnips,  or  other  insipid  food,  when  much 
heated  with  exercise;  which  probably  arises  from  the  sympathy 
between  the  skin  of  the  face  and  the  stomach;  and  may  be  called 
the  gutta  rosea  stomatica.  Which  is  distinguished  from  the  for- 
mer by  the  habits  of  the  patient  in  respect  to  drinking;  by  the  co- 
lour of  the  eruptions  being  less  deep;  and  by  the  patient  conti- 
nuing generally  to  be  troubled  with  some  degree  of  apepsia. 
See  Class  I.  3.  1.  3.  I knew  a lady  who  had  long  been  afflict- 
ed with  pain  about  the  region  of  the  stomach;  and,  on  drinking 
half  a pint  of  vinegar,  as  a medicine,  she  had  a breaking  out 
commenced  on  her  face;  which  remained,  and  she  became  free 
from  the  pain  about  the  stomach.  Was  this  a stomachic,  or  an 
hepatic  disease? 

Thirdly,  there  is  a red  face,  which  consists  of  smaller  pimples 
than  those  above  mentioned;  and  which  is  less  liable  to  suppu- 
rate; and  which  seems  to  be  hereditary,  or  at  least  has  no  appa- 
rent cause  like  those  above  mentioned;  which  may  be  termed 
gutta  rosea  hereditaria •,  or  puncta  rosea. 

Mrs.  S.  had  a pimpled  face,  which  I believe  arose  from  pota- 
tion of  ole.  She  applied  alum  in  a poultice  to  it,  and  had  soon 
a paralytic  stroke,  which  disabled  her  on  one  side,  and  termi- 
nated in  her  death. 

Mrs.  L.  had  a red  pimpled  face,  which  seemed  to  have  been 
derived  from  her  mother,  who  had  probably  acquired  it  by  vi- 
nous potation;  she  applied  a quack  remedy  to  it,  which  I believe 
was  a solution  of  lead,  and  was  seized  with  epileptic  fits,  which 
terminated  in  palsy,  and  destroyed  her.  This  shews  the  danger 
of  using  white  paint  on  the  face,  which  is  called  bismuth,  but  is 


Cuss  II.  1.  4.  6.  OF  SENSATION.  %%% 

in  reality  white  lead  or  cerussa;  and  if  it  be  bismuth,  it  may  be 
equally  deleterious. 

Mr.  Y had  acquired  the  gutta  rosea  on  his  nose,  and  ap- 

plied a saturnine  solution  on  it  for  a few  nights,  and  was  then 
seized  with  paralysis  on  one  side  of  his  face;  which,  however,  he 
gradually  recovered,  and  has  since  acquired  the  gutta  rosea  on 
other  parts  of  his  face. 

These  fatal  effects  were  probably  caused  by  the  disagreeable 
sensation  of  an  inflamed  liver,  which  used  before  to  be  relieved 
by  the  sympathetic  action  and  consequent  inflammation  of  the 
skin  of  the  face,  which  was  now  prevented  by  the  stronger  slimm- 
lus  of  the  application  of  calx  of  lead.  The  manner  in  which  dis- 
agreeable sensations  induce  epilepsy  and  palsy,  is  treated  of  in 
Class  III.  In  some  cases  where  habitual  discharges,  or  erup- 
tions, or  ulcers,  are  stopped,  a torpor  of  the  system  may  follow, 
owing  to  the  want  of  the  accustomed  quantity  of  sensation  or  irri- 
tation. See  Class  I 1.  2.  9.  and  II.  1.  5.  6.  In  both  these  si- 
tuations, some  other  stimulus  should  be  used  to  supply  the  place 
of  that  which  is  taken  away;  which  may  either  be  perpetual,  as 
an  issue;  or  periodical,  as  a cathartic  repeated  once  a fortnight 
or  month. 

Miss  W.  an  elegant  young  lady,  of  about  twenty,  applied  a 
mercurial  lotion  to  her  face,  which  was  covered  with  very  small 
red  points  (which  seemed  to  have  been  not  acquired  by  any 
known  or  avoidable  means);  she  was  seized  with  inflammation 
of  her  liver,  and,  after  repeated  bleeding  and  cathartics,  recov- 
ered; and  in  a few  weeks  the  eruption  appeared  as  before. 

M.  M.  Five  grains  of  calomel  once  a month,  with  a cathar- 
tic, five  grains  of  rhubarb  and  a quarter  of  a grain  of  emetic  tar- 
tar every  night  for  many  weeks.  With  this  preparation  mercu- 
rial plasters,  made  without  turpentine,  and  applied  every  night, 
and  taken  off*  every  morning,  will  sometimes  succeed,  and  may 
be  used  with  safety.  But  blistering  the  face  all  over  the  erup- 
tion, beginning  with  a part,  succeeds  better  than  any  other  means, 
as  I have  more  than  once  experienced.  Something  like  this  is 
mentioned  in  the  Letters  of  Lady  Mary  Wortley  Montague,  who 
blistered  her  face  with  balsam  of  Mecca. 

Mrs.  F.  had  for  many  years  had  a disagreeable  looking  erup- 
tion on  her  chin.  After  a cathartie  with  calomel,  she  was  ad- 
vised to  blister  her  whole  chin;  on  the  healing  of  the  blister,  a 
few  eruptions  again  appeared,  which  ceased  on  the  application 
of  a second  blister.  She  took  rhubarb  five  grains,  and  emetic 
tartar  a quarter  of  a grain,  every  night  for  many  weeks. 

Miss  L.  a young  lady,  about  eighteen,  had  tried  variety  of  ad- 
vice, for  pimples  over  the  greatest  part  of  her  face,  in  vain.  She 


224 


DISEASE'S 


Class  n.  1.  4.  7. 


took  the  above  medicines  internally,  and  blistered  her  face  by 
degrees  all  over,  and  became  quite  beautiful.  A spot  or  two  now 
and  then  appeared,  and  on  this  account  she  frequently  slept  with 
parts  of  her  face  covered  with  mercurial  plaster,  made  without 
turpentine,  which  was  held  on  by  a pasteboard  mask,  and  taken 
off  in  the  mornings;  if  any  part  of  the  plaster  adhered,  a little  but- 
ter or  oil  destroyed  the  adhesion.  If  there  be  turpentine,  or  any 
other  native  balsam,  mixed  with  the  mercurial  plaster,  it  is  very 
liable  much  to  inflame  the  face  (I  suppose  like  the  balsam  of 
Mecca);  but  if  a small  quantity  of  flour  of  brimstone  be  added, 
I believe  it  will  readily  mix.  As  a mercurial  ointment  is  said  to 
be  quickly  made  by  adding  only  six  grains  of  flour  of  sulphur  to 
six  drachms  of  mercury,  and  two  ounces  of  hog’s  grease. 

7.  Odontitis.  Inflammatory  tooth-ach  is  occasioned  by  inflam- 
mation of  the  membranes  of  the  tooth,  or  a caries  of  the  bone  it- 
self. The  gum  sometimes  suppurates,  otherwise  a swelling  of 
the  cheek  succeeds  by  association,  and  thus  the  violence  of  the 
pain  in  the  membranes  of  the  tooth  is  relieved,  and  frequently 
cured;  and  when  this  happens,  the  disease  properly  belongs  to 
Class  IV.  as  it  so  far  resembles  the  translations  of  morbid  actions 
in  the  gout  and  rheumatism. 

At  other  times  the  tooth  dies  without  caries,  especially  in  peo- 
ple about  sixty  years  of  age,  or  before;  and  then  it  stimulates  its 
involving  membrane,  like  any  other  extraneous  substance.  The 
membrane  then  becomes  inflamed  and  thickened,  occasioning 
some  pain,  and  the  tooth  rises  upwards  above  the  rest,  and  is 
gradually  pushed  out  whole  and  undecayed;  on  its  rising  up,  a 
pus-like  mucus  is  seen  discharged  from  the  gum  which  surrouuds 
it;  and  the  gum  seems  to  have  left  the  tooth,  as  the  fangs  or  roots 
of  it  are  in  part  naked. 

M.  M.  Where  the  tooth  is  sound  it  can  only  be  saved  by  eva- 
cuations, by  venesection,  and  a cathartic;  and,  after  its  operation, 
two  grains  of  opium.  A blister  may  also  be  used  behind  the  ear, 
and  ether  applied  to  the  cheek  externally.  In  slighter  cases,  two 
grains  of  opium,  with  or  without  as  much  camphor,  may  be  held 
in  the  mouth,  and  suffered  to  dissolve  near  the  affected  tooth,  aud 
be  gradually  swallowed.  See  Class  I.  2.  4.  12.  Odontalgia 
may  be  distinguished  from  otitis  by  the  application  of  cold  water 
to  the  affected  tooth;  for  as  the  pain  of  common  tooth-ach  is 
owing  to  torpor,  whatever  decreases  stimulus  adds  to  the  torpor 
and  consequent  pain;  whereas  the  pain  of  an  inflamed  tooth, 
being  caused  by  the  increased  action  of  the  membranes  of  it,  is 
in  some  measure  alleviated  by  the  application  of  cold. 

8,  Otitis.  Inflammation  and  consequent  suppuration  of  some 


Class  If.  1.  4.  9. 


OF  SENSATION. 


225 


membranes  of  the  internal  ear  frequently  occur  in  children,  who 
sleep  in  cold  rooms,  or  near  a cold  wall,  without  a night-cap. 
If  the  bones  are  affected,  they  come  out  in  a long  process  of  lime, 
and  the  child  remains  deaf  of  that  ear.  But  in  this  case  there  is 
generally  a 'fever  attends  this  inflammation;  and  it  then  belongs 
to  another  genus. 

M.  M.  A warmer  night-cap.  Warmish  water  should  be 
gently  syringed  into  the  ear,  tod  keep  it  clean,  twice  a day;  and 
if  it  does  not  heal  in  a week,  a little  spirit  of  wine  should  be 
added;  first  about  a fourth  part,  and  it  should  be  gradually  in- 
creased to  half  rectified  spirit  and  half  water:  if  it  continues 
long  to  discharge  matter  with  a very  putrid  smell  the  bones  are 
injured,  and  will  in  time  find  their  exit;  during  which  time 
the  ear  should  be  kept  clean,  by  filling  it  with  a weaker  mixture 
of  spirit  of  wine  and  water,  or  a solution  of  alum  in  water, 
which  may  be  poured  into  the  ear,  as  the  head  is  inclined,  and 
shook  out  again  by  turning  the  head,  two  or  three  times,  morn- 
ing and  evening.  See  Class  II.  1.  4.  10. 

9.  Fistula  lacrymalis.  Thelacrymal  sack,  with  its  puncta  la- 
crymalia  and  nasal  duct,  are  liable  to  be  destroyed  by  suppuration 
without  fever;  the  tears  then  run  over  the  eyelids,  and  inflame 
the  edges  of  them  and  the  cheeks,  by  their  perpetual  moisture 
and  saline  acrimony. 

M.  M.  By  a nice  surgical  operation,  a new  aperture  is  to  be 
made  from  the  internal  corner  of  the  eye  into  the  nostril,  and  a 
silver  tube  introduced,  which  supplies  the  defect  by  admitting 
the  tears  to  pass  again  into  the  nostril.  See  Melanges  de  Chi- 
rurgie,  par  M.  Pouteau;  who  thinks  he  has  improved  this  opera- 
tion. 

10.  Fistula  in  ano.  A mucous  discharge  from  the  anus,  call- 
ed by  some  white  piles,  or  matter  from  a suppurated  pile,  has 
been  mistaken  for  the  matter  from  a concealed  fistula.  A bit  of 
cotton-wool  applied  to  the  fundament  to  receive  the  matter,  and 
renewed  twice  a day  for  a week  or  two,  should  always  be  used 
before  examination  with  the  probe.  The  probe  of  an  unskilful 
empyric  sometimes  does  more  harm  in  the  loose  cellular  mem- 
brane of  these  parts  than  the  original  ulcer,  by  making  a fistula 
he  did  not  find.  The  cure  of  a fistula  in  ano,  of  those  who  have 
been  much  addicted  to  drinking  spiritous  liquor,  or  who  have 
a tendency  to  pulmonary  consumption,  is  frequently  of  danger- 
ous consequence,  and  is  succeeded  by  ulcers  of  the  lungs,  and 
death. 

M.  M.  Ward’s  paste,  or  20  black  pepper- corns  taken  after 
each  meal  twice  a day;  the  pepper-corns  should  be  cut  each  in- 
to two  or  three  pieces.  The  late  Dr.  Munro,  of  Edinburgh, 

roL.  II.  Gg 


226 


DISEASES 


Class  II.  1.  4.  11. 


asserted,  in  his  lectures,  that  he  had  known  a fistula  in  ano  cured 
by  injecting  first  a mixture  of  rectified  spirit  of  wine  and  water: 
and,  by  gradually  increasing  the  strength  of  it,  till  the  patient 
could  bear  rectified  spirit  alone;  by  the  daily  use  of  which,  at 
length,  the  sides  of  the  fistula  became  callous,  and  ceased  to  dis- 
charge though  the  cavity  was  left.  A French  surgeon  has 
lasely  affirmed,  that  a wire  of  lead  put  in  at  the  external  open- 
ing of  the  ulcer,  and  brought  through  the  rectum,  and  twisted 
together,  will  gradually  wear  itself  through  the  gut,  and  thus  ef- 
fect a cure  without  much  pain.  The  ends  of  the  leaden  wire 
must  be  twisted  more  and  more  as  it  becomes  loose.  Or,  lastly, 
it  must  be  laid  open  by  the  knife. 

1 1 . Fistula  urethra.  Where  a stricture  of  the  urethra  exists, 
from  whatever  cause,  the  patient,  in  forcing  the  stream  of  urine 
through  the  stricture,  distends  the  urethra  behind  it;  which, 
after  a time,  is  liable  to  burst,  and  to  become  perforated;  and 
some  of  the  urine  is  pushed  into  the  cellular  membrane,  occa- 
sioning fistulas,  which  sometimes  have  large  surfaces  producing 
much  matter,  which  is  pressed  out  at  the  time  of  making  water, 
and  has  been  mistaken  for  a catarrh  of  the  bladder;  these  fistu- 
las sometimes  acquire  an  external  opening  in  the  perinaeum,  and 
part  of  the  urine  is  discharged  that  way. 

Can  this  matter  be  distinguished  from  mucus  of  the  bladder  by 
the  criterion  delivered  in  Class  II.  1.  6.  6.? 

M.  M.  The  perpetual  use  of  bougies,  either  of  catgut  or  of 
caoutchouc.  The  latter  may  be  had  at  No.  37,  Red-lion  street, 
Holborn,  London.  The  former  are  easily  made,  by  moistening 
the  catgut,  and  keeping  it  stretched  till  dry,  and  then  rounding 
one  end  with  a pen-knife.  The  use  of  a warm  bath  ever}'  day 
for  near  an  hour,  at  the  heat  of  94  or  96  degrees,  for  two  or 
three  months,  I knew  to  be  uncommonly  successful  in  one  case; 
the  extensive  fistulas  completely  healing.  The  patient  should 
introduce  a bougie  always  before  he  makes  water,  and  endeavour 
to  make  it  as  slowly  as  possible.  See  Class  I.  2.  3.  24. 

12.  Hepatitis  chronica.  Chronical  inflammation  of  the  liver. 
A collection  of  matter  in  the  liver  has  frequently  been  found  on 
dissection,  which  w'as  not  suspected  in  the  living  subject.  Though 
there  may  have  been  no  certain  signs  of  such  a collection  of 
matter,  owing  to  the  insensibility  of  the  internal  parts  of  this 
viscus;  which  has  thus  neither  been  attended  with  pain,  nor  in- 
duced any  fever;  yet  there  may  be  in  some  cases  reason  to  sus- 
pect the  existence  of  such  an  abscess;  either  from  a sense  of  ful- 
ness in  the  right  hypochondre,  or  from  transient  pains  sometimes 
felt  there,  or  from  pain  on  pressure,  or  from  lying  on  the  left  side, 
and  sometimes  from  a degree  of  sensitive  fever  attending  it. 


Ol ass  II.  1.  4 13. 


OP  SENSATION. 


227- 


Dr.  Saunders  suspects  the  acute  hepatitis  to  exist  in  the  in- 
flammation of  the  hepatic  artery,  and  the  chronical  one  in  that 
of  the  vena  portarum.  Treatise  on  the  Liver.  Robinsons. 
London. 

13.  Scrofula  suppurcins.  Suppurating  scrofula.  The  indolent 
tumours  of  the  lymphatic  glands  are  liable,  after  a long  time,  to 
regain  their  sensibility;  and  then,  owing  to  their  former  torpor, 
an  increased  action  of  the  vessels,  beyond  what  is  natural,  with 
inflammation,  is  the  consequence  of  their  new  life,  and  suppura- 
tion succeeds.  This  cure  of  scrofula  generally  happens  about 
puberty,  when  a new  energy  pervades  the  whole  system,  and  un- 
folds the  glands  and  organs  of  reproduction. 

M.  M.  See  Class  I.  2.  3.  21.  Where  scrofulous  ulcers  about 
the  neck  are  difficult  to  heal,  Dr.  Beddoes  was  informed,  in  Ire- 
land, that  an  empyric  had  had  some  success  by  inflaming  them  by 
an  application  of  wood  sorrel,  oxalis  aceto  sella,  the  leaves  of  which 
are  bruised  in  a mortar,  and  applied  on  the  ulcers  for  two  or 
three  days,  and  then  some  more  lenient  application  is  used. 

A poor  boy,  about  twelve  years  old,  had  a large  scrofulous 
ulcer  on  one  side  of  the  chest  beneath  the  clavicle,  and  another 
under  his  jaw;  he  was  directed,  about  three  weeks  ago,  to  pro- 
cure a pound  of  dry  oak-bark  from  the  tanners,  and  to  reduce  it 
to  fine  powder,  and  to  add  to  it  one  ounce  of  white  lead  in  fine 
powder,  and  to  cover  the  ulcers  daily  with  it,  keeping  it  on  by 
brown  paper  and  a bandage.  He  came  to  me  a few  minutes  ago^ 
to  shew  me  that  both  the  ulcers  are  quite  healed.  The  constant 
application  of  linen  rags,  moistened  with  a solution  of  an  ounce 
of  sugar  of  lead  in  a pint  of  water,  I think  I have  seen  equally 
efficacious. 

Small  doses  internally  of  a solution  of  arsenic  have  been  said 
to  contribute  to  cure  these  ulcers.  I should  recommend  from  one 
drop  to  five  of  a saturated  decoction  of  arsenic,  as  directed  in 
Mat.  Med.  Art.  IV.  2.  6.  8.  for  children,  twice  or  thrice  a day, 
according  to  their  age,  and  from  five  to  ten  to  grown  persons, 
diminishing  the  quantity  if  it  affects  the  bowels.  Tincture  of 
digitalis  is  recommended  in  Class  I.  2.  3.  21. 

14.  Scorbutus  suppurans.  In  the  sea-scurvy  there  exists  an 
inactivity  of  venous  absorption,  whence  vibices  and  petechias, 
and  sometimes  ulcers.  As  the  column  of  blood  pressing  on  the 
origins  of  the  veins  of  the  lower  extremities,  when  the  body  is 
erect,  opposes  the  ascent  of  the  blood  in  them,  they  are  more 
frequently  liable  to  become  enlarged,  and  to  produce  varixes,  or 
vibices,  or,  lastly,  ulcers  about  the  legs,  than  on  the  upper  parts 
of  the  body.  The  exposure  to  cold  is  believed  to  be  another 
cause  of  ulcers  on  the  extremities;  as  happens  to  many  of  the 


228 


DISEASES 


Class  II.  1.  4.  15. 


poor  in  winter,  at  Lisbon,  who  sleep  in  the  open  air,  without 
sto<  kings,  on  the  steps  of  their  churches  or  palaces.  See  Class  I. 

2.  1.  15. 

M.  M.  A bandage  spread  with  plaster  to  cover  the  whole 
limb  tight.  Rags  dipped  in  a solution  of  sugar  of  lead.  A 
warm  flannel  stocking  or  roller.  White  lead  and  oak-bark, 
both  in  fine  powder.  Horizontal  rest.  An  ingenious  treatise  on 
the  use  of  bandage,  in  the  cure  of  ulcers,  has  lately  been  publish- 
ed bv  Mr.  Baynton,  of  Bristol;  and  another,  on  the  same  subject, 
by  Mr.  Whately,  of  London,  who  succeeds  without  using  plaster 
on  the  bandage. 

15.  Scirrhus  suppurans.  When  a scirrbus  affects  any  gland 
of  no  great  extent  or  sensibility,  it  is,  after  a long  period  of  time, 
liable  to  suppurate  without  inducing  fever,  like  the  indolent  tu- 
mours of  the  conglobate  or  lymphatic  glands  above  mentioned: 
whence  collections  of  matter  are  often  found  after  death,  both  in 
men  and  other  animals:  as  in  the  livers  of  swine,  which  have  been 
fed  with  the  grounds  of  fermented  mixtures  in  the  distilleries. 
Another  termination  of  scirrhus  is  in  cancer,  as  described  below. 
See  Class  I.  2.  3.  22. 

16.  Carcinoma.  Cancer.  When  a scirrhous  tumour  regains 
its  sensibility  by  nature,  or  by  any  accidental  hurt,  new  vessels 
shoot  amongst  the  yet  insensible  parts  of  it,  and  a new  secretion 
takes  place  of  a very  injurious  material.  This  cancerous  mat- 
ter is  absorbed,  and  induces  swelling  of  the  neighbouring  lympha- 
tic glands;  which  also  become  scirrhous,  and  afterwards  can- 
cerous. 

This  cancerous  matter  does  not  seem  to  acquire  its  malignant 
or  contagious  quality,  till  the  cancer  becomes  an  open  ulcer;  and 
the  matter  secreted  in  it  is  thus  exposed  to  the  air.  Then  it  evi- 
dently becomes  contagious,  because  it  not  only  produces  hectic 
fever,  like  common  matter  in  ulcers  open  to  the  air,  but  it  also, 
as  it  becomes  absorbed,  swells  the  lymphatic  glands  in  its  vicinity; 
as  those  of  the  axilla,  when  the  open  cancer  is  on  the  breast. 
See  Class  II.  1.  3. 

Hence  exsection  before  the  cancer  is  open  is  generally  a 
cure;  but  after  the  matter  has  been  exposed  to  the  air,  it  is  sel- 
dom of  service;  as  the  neighbouring  lymphatic  glands  are  already 
infected.  I have  observed  some  of  these  patients  after  the  opera- 
tion to  have  had  diseased  livers,  which  might  either  have  pre- 
viously existed,  or  have  been  produced  by  the  fear  or  anxiety  at- 
tending the  operation. 

Erosin  with  arsenic,  after  the  cancer  is  become  an  open  ul- 
cer, has  generally  no  belter  effect  than  exsection,  but  has  been 
successful  before  ulceration.  The  best  manner  of  using  arsenic. 


Class.  II.  1.  4. 19. 


OF  SENSATION. 


229 


is  by  mixing  one  grain  with  a drachm  of  lapis  calaminaris,  and 
strewing  on  the  cancer  some  of  the  powder  every  day,  till  the 
whole  is  destroyed. 

Cancers  on  the  face  are  said  to  arise  from  the  periosteum,  and 
that,  unless  this  be  destroyed  by  the  knife,  or  by  caustics,  the 
cancer  certainly  recurs.  After  the  cancer  becomes  an  open 
ulcer  of  some  extent,  a purulent  fever  supervenes,  as  from  other 
open  ulcers,  and  graduailv  destroys  the  patient.  See  Class  II. 
1.6.13. 

Two  very  interesting  cases  have  been  lately  published  by  Dr. 
Ewart,  of  Ba  h,  in  which  carbonic  acid  gas,  or  fixed  air,  was 
kept  constantly  in  contact  with  the  open  cancerous  ulcers  of  the 
breast;  which  then  healed  like  other  common  ulcers.  This  is 
rather  to  be  ascribed  to  the  exclusion  of  oxygen,  than  to  any 
specific  virtue  in  the  carbonic  acid.  As  in  common  ulcers  the 
matter  does  not  induce  hectic  fever,  till  it  has  been  exposed  to 
the  air,  and  then  probably  united  with  oxygen. 

The  manner  of  applying  the  fixed  air,  is  by  including  the  can- 
cer in  one  half,  or  hemisphere,  of  a large  bladder;  the  edges  are 
made  to  adhere  to  the  skin  by  adhesive  plaster,  or  perhaps  a 
mixture  of  one  part  of  honey  with  about  twenty  parts  of  car- 
penter’s glue  might  better  suit  some  tender  skins.  The  bladder 
is  then  kept  constantly  filled  with  carbonic  acid  gas,  by  means 
of  a pipe  in  the  neck  of  it;  and  the  matter  let  out  at  a small  aper- 
ture beneath. 

M.  M.  Where  extirpation  is  not  advisable,  as  in  most  open 
cancers  of  the  breast,  keep  the  ulcer  carefully  from  the  air,  either 
by  applying  carbonic  acid  gas,  as  above;  or  by  covering  it  with 
charcoal  in  powder,  and  a double  oiled  silk.  The  charcoal-pow- 
der should  be  renewed  once  in  two  or  three  days,  and  at  those 
times  it  should  be  pushed  oft'  by  fresh  charcoal -powder  on  lint, 
so  as  not  for  a moment  to  expose  it  to  the  air.  The  charcoal 
should  be  fresh  taken  from  the  fire,  and  powdered  very  fine  as 
soon  as  cool,  and  kept  in  a bottle  to  be  as  little  exposed  to  the 
air  as  possible. 

The  tumour  should  be  suspended  by  a sash  or  soft  cushion,  so 
as  to  keep  it  as  easy  as  possible  night  and  day,  and  should  be  kept 
neither  too  warm  nor  too  cold,  as  both  extremes  are  injurious. 

Internally,  six  grains  of  rhubarb  every  night,  for  many  months, 
and  to  drink  nothing  stronger  than  common  weak  small  beer, 
consisting  of  three  strike  of  malt  to  the  hogshead,  or  wine  diluted 
with  thrice  its  quantity  of  water. 

If  caustics  cannot  be  applied  so  as  to  destroy  the  whole,  even 
before  ulceration,  I suspect  that  they  aggravate  the  evil,  and 
sooner  destroy  the  patient;  as,  I was  well  informed,  occurred 


DISEASES 


Class  II.  1.  4.  17. 


&30 

to  a quack  who  was  for  a time  much  resorted  to,  in  this  part  of 
the  country. 

Another  method  of  using  charcoal-powder  is  by  mixing  it  with 
boiling  oil,  to  the  consistence  of  common  paint;  and  to  soak  a 
piece  of  flannel  with  this,  and  cover  the  ulcer;  and  daily  to 
shove  or  thrust  this  off  by  applying  the  edge  of  another  piece  of 
flannel,  soaked  with  the  oil  and  charcoal,  to  the  edge  of  that  upon 
the  ulcer,  so  as  to  change  them  without  the  possibility  of  letting 
any  air  come  into  contact  with  the  cancerous  sore. 

17.  Arlhrocelc.  Swelling  of  the  joints  seems  to  have  its  remote 
cause  in  the  softness  of  the  bones,  for  they  could  not  swell  unless 
they  were  previously  softened,  see  Class  I.  2.  2.  12.  The  epiphy- 
ses, or  ends  of  the  bones,  being  naturally  of  a looser  texture,  are 
most  liable  to  this  disease,  and  perhaps  the  cartilages  and  capsu- 
lar ligaments  may  also  become  inflamed  and  swelled  along  with 
the  heads  of  the  bones.  This  malady  is  liable  to  distort  the  fin- 
gers and  knees,  and  is  usually  called  gout  or  rheumatism;  the 
former  of  which  is  liable  to  disable  the  fingers  by  chalk-stones, 
and  thence  to  have  somewhat  a similar  appearance.  But  the 
arthrocele,  or  swelling  of  the  joints,  affects  people  who  have  not 
been  intemperate  in  the  use  of  fermented  or  spirituous  liquors; 
or  who  have  not  previously  had  a regular  gout  in  their  feet;  and 
in  both  these  circumstances  differs  from  the  gout.  Nor  does 
it  accord  with  the  inflammatory  rheumatism,  as  it  is  not  attended 
with  fever,  and  because  the  tumours  of  the  joints  never  entirely 
subside.  The  pain  or  sensibility  which  the  bones  acquire  when 
they  are  inflamed,  may  be  owing  to  the  new  vessels,  which  shoot 
in  them  in  their  soft  state,  as  well  as  to  the  distention  of  the  old 
ones. 

M.  M.  Half  a grain  of  opium  twice  a day,  gradually  increased 
to  a grain,  but  not  further,  for  many  months.  Thirty  grains  of 
poivder  of  bark  twdce  a day  for  many  months.  Ten  grains  of 
bone-ashes,  or  calcined  hartshorn,  twice  a day,  with  decoction 
of  madder?  Soda  phosphorata? 

18.  Arthropuosis.  Joint-evil.  This  differs  from  the  former, 
as  that  never  suppurates;  these  ulcers  of  the  joints  are  generally 
esteemed  to  arise  from  scrofula;  but  as  scrofula  is  a disease  of  the 
lymphatic  or  absorbent  system,  and  this  consists  in  the  suppuration 
of  the  membranes,  or  glands,  or  cartilages,  about  the  joints,  there 
does  not  seem  a sufficient  analogy  to  authorize  their  arrangement 
under  the  same  name. 

The  white  swelling  of  the  knee,  when  it  suppurates,  come? 
under  this  species,  with  variety  of  other  ulcers,  attended  with  ca- 
rious bones. 

19.  Caries  ossium , or  Necrosis  ossium.  A caries  of  the  bone- 


G£ass  II.  1.  4.  19. 


OF  SENSATION. 


'231 

may  be  termed  a suppuration  of  them;  it  differs  from  the  above 
as  it  generally  is  occasioned  by  some  external  injury,  as  in  decay- 
ing teeth;  or  by  venereal  virus,  as  in  nodes  on  the  tibia;  or  by 
other  matter  derived  to  the  bone  in  malignant  fevers;  and  is 
not  confined  to  the  ends  of  them. 

The  separation  of  the  dead  bone  from  the  living  is  a work  of 
some  time.  See  Sect.  XXXIII.  3.  1.  A new  and  able  work  on 
the  necrosis  of  bones  is  published  by  I.  Russell,  Edinburgh; 
London,  Robinsons.  And  another  by  I.  P.  Weidmann,  de  Ne- 
crosi  Ossium,  at  Francfort;  Boosey,  London;  which  is  also  a val- 
uable work. 

M.  M.  When  this  disease  is  not  formed  in  syphilis,  or  by 
metastasis  in  fever,  but  is  simply  an  inflammation  of  the  perios- 
teum or  of  the  solid  bone,  or  of  its  medullary  cells,  the  method 
of  cure  should  consist  in  evacuations  by  bleeding  and  cathartics, 
and  by  leeches  applied  to  the  painful  or  tumid  parts;  and  after- 
wards by  taking  inwardly  soda  phosphorata  and  a decoction  of 
rubia  tinctorum,  madder-root;  as  the  former  is  believed  to  give 
solidity  to  bones,  and  the  latter,  as  it  colours  the  bones  of  young 
or  growing  animals,  is  known  to  be  carried  thither  during  their 
softer  or  more  sensitive  state,  and  may  be  therefore  worth  a trial: 
See  Innutritio  ossium.  Class  I.  2.  2.  14. 


232 


DISEASES 


Class  II.  1.  5.  1. 


ORDO  I. 

Increased  Sensation. 

GENUS  V. 

. With  the  production  of  new  Vessels  by  external  Membranes  or 
Glands , without  Fever. 

The  ulcers,  or  eruptions,  which  are  formed  on  the  external 
skin,  or  on  the  mouth  or  throat,  or  on  tiie  air-cells  of  the  lungs 
or  on  the  intestines,  all  of  which  are  more  or  less  exposed  to  the 
contact  of  the  atmospheric  air,  which  we  breathe,  and  which  in 
some  proportion  we  swallow  with  our  food  and  saliva;  or  to 
the  contact  of  the  inllammable  air,  or  hydrogen,  which  is  set  at 
liberty  by  the  putrefying  aliment  in  the  intestines,  or  by  putrefy- 
ing matter  in  large  abscesses;  all  of  them  produce  contagious  mat- 
ter; which,  on  being  inoculated  into  the  skin  of  another  person, 
will  produce  fever,  or  a similar  disease. 

In  some  cases  even  the  matter  formed  beneath  the  skin  be- 
comes in  some  degree  contagious,  at  least  so  much  so  as  to  pro- 
duce fever  of  the  hectic  or  malignant  kind,  as  soon  as  it  has 
pierced  through  the  skin,  and  has  thus  gained  access  to  some 
kind  of  air;  as  the  fresh  pus  of  a common  abscess;  or  the  putrid 
pus  of  an  abscess  which  has  been  long  confined;  or  of  cancerous 
ulcers. 

From  this  analogy  there  is  reason  to  suspect  that  the  matter  of 
all  contagious  diseases,  whether  with  or  without  fever,  is  not  in- 
fectious till  it  has  acquired  something  from  the  air:  which,  by 
oxygenating  the  secreted  matter,  may  probably  produce  a new 
acid.  And,  secondly,  that  in  hectic  fever  a part  of  the  purulent 
matter  is  absorbed;  or  acts  on  the  surface  of  the  ulcer;  as  va- 
riolous matter  affects  the  inoculated  part  of  the  arm.  And  that 
hectic  fever  is  therefore  caused  bv  the  matter  of  an  open  ulcer; 
and  not  by  the  sensation  in  the  ulcer  independent  of  the  aerated 
pus,  which  lies  on  it.  Which  may  account  for  the  venereal  mat- 
ter from  buboes  not  giving  the  infection,  according  to  the  experi- 
ments of  the  late  Mr.  Hunter,  and  for  some  other  phenomena 
of  contagion.  See  Variola  discreta,  Class  II.  1.  3.  9. 

SPECIES. 

1.  Gonorrhoea  venerea.  A pus-like  contagious  material  dis- 
charged from  the  urethra  after  impure  cohabitation,  with  smart- 


Class  II.  1.  5. 1. 


OF  SENSATION. 


233 


ing  or  heat  on  making  water;  which  begins  at  the  external  ex- 
tremity of  the  urethra,  to  which  the  contagious  matter  is  applied, 
and  where  it  has  access  to  the  air;  which  probably  heightens  its 
acrimony. 

M.  M.  In  this  state  of  the  venereal  disease,  one  venesection, 
with  mild  cathartics  of  senna  and  manna,  with  mucilage,  as  al- 
mond emulsion,  and  gum  arabic,  taken  for  two  or  three  weeks, 
absolve  the  cure.  Is  camphor  of  use  to  relieve  the  ardor  urinae? 
Do  baliams  increase  or  lessen  the  heat  of  urine?  Neutral  salts 
certainly  increase  the  smarting  in  making  water,  by  increasing 
the  acrimony  of  the  urine. 

Can  the  discharge  from  the  urethra  be  soon  stopped  by  satur- 
nine injections,  or  mercurial  ones,  or  with  solution  of  blue  vitriol, 
at  first  very  dilute,  and  gradually  made  stronger?  And  at  the  same 
time,  lest  the  syphilis,  or  general  disease,  should  supervene,  the 
patient  might  take  a quarter  of  a grain  of  corrosive  sublimate  of 
mercury  twice  a day,  as  directed  below? 

There  is  a curious  paper  by  Mr.  Addiugton,  of  West  Bromage, 
in  the  Contributions  of  Medical  Knowledge,  published  by  Dr. 
Beddoes,  on  the  cure  of  gonorrhoea  virulenta,  by  large  doses  of 
corrosive  sublimate  of  mercury,  hydrargyrus  muriatus.  Three 
grains  of  corrosive  sublimate  of  mercury  are  dissolved  in  one  ounce 
of  rectified  spirit  of  wine.  Half  of  this  mixture  is  taken  undiluted 
at  going  to  bed;  it  produces  a copious  salivation  for  an  hour  and 
a half,  or  longer,  during  which  the  patient  spits  a quart.  Some 
Glauber’s  salts  are  to  be  taken  on  the  second  day  after  this  ope- 
ration, and  on  the  evening  of  that  day  he  is  to  repeat  the  draught, 
and  the  salts  on  the  day  but  one  following.  And  Mr.  Addington 
witnessed  that  three  or  four  such  doses  frequently  cured  a vene- 
real gonorrhoea  in  so  short  a time,  without  any  disagreeable  con- 
sequence, and  was  informed  that  hundreds  had  been  cured  by  it. 

The  probable  mode  of  action  of  this  medicine  is  owing  to  the 
consent  of  parts  between  the  throat  and  the  urethra,  of  which 
many  instances  are  given  in  Class  IV.  1.2.7.  on  Hydrophobia. 
Mr.  Wright,  an  elderly  surgeon  in  Derby,  thirty  years  ago,  as- 
sured me,  that  he  had  frequently  given  half  a drachm  of  corro- 
sive sublimate  as  an  emetic,  without  any  inconvenience  to  the 
patient;  and  that  it  was  the  famous  emetic  of  a celebrated  em- 
pyric,  and  had  been  said  to  do  wonders. 

Might  not  this  dose  of  one  grain  and  a half,  dissolved  in  half 
an  ounce  of  rectified  spirit,  be  given  repeatedly,  wfith  prospect  of 
advantage,  in  hydrophobia?  And  perhaps,  in  an  adapted  strength 
and  quantity,  in  hydrocephalus?  If  in  croup,  peripneumonia 
trachealis? 

h h 


VOL.  II. 


234 


DISEASES 


Ciass  II.  1.  5.  2, 


2.  Syphilis.  Venereal  disease.  The  contagion  shews  itself 
in  ulcers  on  the  part  first  inoculated  as  chancres;  ulcers  on  the 
tonsils  succeed,  with  eruption  on  the  skin,  especially  about  the 
roots  of  the  hair;  afterwards  on  other  parts  of  the  skin,  terminat- 
ing in  dry  scabs;  and  lastly,  with  pain  and  swelling  of  the  bones. 

The  corona  veneris,  or  crown  of  Venus,  consists  of  the  erup- 
tions at  the  roots  of  the  hair,  appearing  most  round  the  forehead; 
which  is  occasioned  by  this  part  being  more  exposed  to  the  air; 
which  we  observed  at  the  beginning  of  this  genus,  either  produces 
or  increases  the  virulence  of  contagious  matter.  But  it  is  diffi- 
cult to  conceive,  from  this  history,  why  the  throat  should  be  first 
affected;  as  it  cannot  be  supposed,  that  the  disease  is  so  often 
taken  by  the  saliva,  like  the  small-pox,  though  this  may  some- 
times occur;  perhaps  very  often.  The  connexion  between  the 
genitals  in  men  and  the  throat,  is  treated  of  in  Class  IV.  1.  2.  7. 
Hydrophobia. 

M.  M.  A quarter  of  a grain  of  corrosive  sublimate  of  mer- 
cury, taken  thrice  a day  for  five  or  six  weeks,  made  into  a pill 
with  bread  crumbs,  or  dissolved  in  a spoonful  of  brandy  and 
water,  is  a very  efficacious  and  almost  certain  cure.  When  it 
does  not  succeed,  it  is  owing  either  to  the  drug  being  bad,  or  to 
its  having  precipitated  from  the  brandy,  or  from  its  being  spoiled 
in  the  pill  by  long  keeping.  Opium  contributes  much  to  expe- 
dite the  cure,  both  of  the  simple  gonorrhoea  and  of  venereal  ul- 
cers, by  increasing  absorption  both  from  the  mucous  membrane 
and  from  the  surface  of  ulcers.  A quarter  of  a grain,  or  half  a 
grain,  may  be  given  with  every  dose  of  the  sublimate. 

Nitrous  acid  has  been  lately  strongly  recommended,  by  Mr. 
Scott,  in  venereal  cases;  from  an  idea  that  the  oxygene,  which 
it  consists  of  in  part,  is  loosely  combined,  and  may  be  separable 
in  the  animal  system;  and  that  it  may  be  the  oxygene,  only,  which 
exists  loosely  in  mercurial  calces  or  oxydes,  that  acts  so  success- 
fully, when  mercurials  are  exhibited.  Some  successful  exhibitions 
of  this  acid  in  venereal  cases  are  published;  the  dose  is  one  drachm 
and  a half,  or  two  drachms,  of  the  strong  nitric  acid  mixed  in  two 
pounds  of  water,  to  be  drunk  daily  at  repeated  intervals.  Mr. 
Scott  has  since  used  the  nitrous  acid  much  diluted  with  water 
externally  as  a warm  bath,  either  partially  or  generally,  with 
great  success,  at  Bombay,  in  venereal  cases.  See  Article  II.  2. 
4.  and  IV.  2.  7.  1.  in  the  Materia  Medica. 

It  has  been  now  used  in  this  country  with  success  by  some, 
and  without  success  by  others,  and  may  perhaps  assist  the  use  of 
mercurials  as  well  as  opium  in  the  cure  of  venereal  ulcers;  but 
should  not  yet  be  solely  depended  upon. 


Ciass  II.  1.  5.  3. 


OF  SENSATION. 


235 


3.  Lepra.  Leprosy.  Leprosy  of  the  Greeks.  The  skin  is 
rough  with  white  branny  scales,  which  are  full  of  chinks;  often 
moist  beneath,  and  itching.  The  scales  on  the  head  or  arms  of 
some  drinking  people  are  a disease  of  this  kind.  The  perspirable 
matter  designed  for  the  purpose  of  lubricating  the  external  skin 
is  secreted  in  this  disease  in  a too  viscid  state,  owing  to  the  in- 
flammation of  the  subcutaneous  vessels;  and,  as  the  absorbents 
act  too  strongly  at  the  same  time,  a viscid  mucus  is  left  adhering 
to  the  surface  of  the  skin. 

In  the  leprosy  of  the  JeAvs,  described  in  the  thirteenth  and 
fourteenth  chapters  of  Leviticus,  the  depression  of  the  sore  be- 
neath the  surface  of  the  skin,  and  the  hairs  in  it  becoming  Avhite, 
seem  to  have  been  the  principal  circumstances,  which  the  priest 
was  directed  to  attend  to  for  the  purpose  of  ascertaining  the  dis- 
ease. 

M.  M.  Essence  of  antimony,  from  20  drops  to  100,  twice  or 
thrice  a day,  Avith  half  a pint  of  decoction  of  elm-bark;  or  of 
malt-tea;  or  tincture  of  cantharides,  from  20  to  60  drops,  four 
times  a day;  or  sublimate  of  mercury,  with  much  diluting 
fluid.  Acid  of  vitriol?  Perhaps  the  cure  chiefly  depends  on 
much  dilution  with  water,  from  tivo  to  four  pints  a day,  in 
which  elm-bark,  or  pine-buds,  or  juniper-tops,  may  be  boiled. 
Bath  or  Buxton  Avater  drunk  in  large  quantities.  Warm  bath 
Oil-skin  bound  on  the  part  to  confine  the  perspirable  matter. 
Ointment  of  tar  and  suet;  or  poultice  for  Iavo  or  three  days,  and 
then  cerate  with  lapis  calaminaris.  Diet  of  raisins  and  bread. 
Abstinence  from  Avine,  beer,  and  all  spirits,  is  indispensably  ne- 
cessary to  the  cure. 

4.  Elephantiasis.  Leprosy  of  the  Arabs.  A contagious  dis- 
ease; the  skin  is  thickened,  Avrinkled,  rough,  unctuous,  destitute 
of  hair,  Avithout  any  sensation  of  touch  in  the  extremities  of  the 
limbs;  the  face  deformed  Avith  tubercles;  the  voice  hoarse,  and 
Avith  a nasal  tone.  Cullen. 

5.  Framboesia.  Yaws  is  said  to  be  contagious  and  hereditary. 
It  principally  affects  the  negroes  in  the  West-Indies.  Edinb. 
Essays,  Vol.  VI. 

6.  Psora.  Itch.  A contagious  prurient  eruption.  There 
are  tAvo  kinds  of  itch:  that  Avhich  appears  between  the  fingers 
and  under  the  joints  of  the  knees  and  elbows;  and  that  Avhich 
seldom  is  seen  in  these  places,  but  all  over  the  other  parts  of  the 
body.  The  latter  is  seldom  thought  to  be  the  itch,  as  it  does  not 
easily  infect  even  a bed-felloAV,  and  resists  the  usual  means  of 
cure  by  brimstone. 

If  the  itch  be  cured  too  hastily,  by  rubbing  mercurial  or  arse- 
nical preparations  over  the  whole  body,  or  on  too  great  a part 


236 


DISEASES 


Class  II.  1.5.  G. 


of  it,  many  bad  symptoms  are  produced;  as  weakness  of  diges- 
tion, with  pale  bloated  countenance,  and  tendency  to  dropsy.  I 
have  twice  seen  St.  Vitus’s  dance  occur,  from  the  use  of  a mer- 
curial girdle;  and  once  a swelled  liver.  I have  also  seen  a swelled 
spleen  and  swelled  legs  from  the  external  use  of  arsenic  in  the 
cure  of  the  itch.  And  very  numerous  and  large  phlegmons  com- 
monly succeed  the  too  hasty  cure  of  it  by  other  means. 

There  does  not  appear  a strict  analogy  between  the  hasty  cure 
of  the  itch,  and  the  retrocession  of  the  pustules  in  the  secondary 
fever  of  the  small-pox;  because  in  that  the  absorption  of  the 
matter  is  evinced  by  the  swelling  of  the  face  and  hands,  as 
the  pustules  recede,  as  explained  in  Class  II.  1.  3.  9.  Variola 
discreta.  And  a fever  is  produced  by  this  absorption;  neither  of 
which  happen,  when  the  pustules  of  the  itch  are  destroyed  by 
mercury  or  arsenic. 

Nor  can  these  inconveniences,  which  occur  on  the  too  hasty 
cure  of  the  itch,  be  explained  by  those  which  follow  the  cure  of 
some  kinds  of  gutta  rosea,  Class  II.  1.4.  6.  as  in  those  the  erup- 
tions on  the  face  were  an  associated  disease  with  inflammation 
of  the  liver  or  stomach,  which  they  were  accustomed  to  relieve; 
whereas  the  itch  is  not  known  to  have  had  any  previous  catena- 
tion with  other  diseases. 

In  the  itch  there  exists  not  only  great  irritation  in  the  produc- 
tion of  the  pustules,  but  great  sensation  is  caused  by  their  acri- 
mony afterwards;  insomuch  that  the  pain  of  itching  without  the 
interrupted  smarting  occasioned  by  scratching,  would  be  intole- 
rable. This  great  excitement  of  the  two  sensorial  powers  of 
irritation  and  sensation  is  so  great,  when  the  pustules  are  diffused 
over  the  whole  surface  of  the  body,  that  a torpor  succeeds  the 
sudden  ceasing  of  it;  which  affects  those  parts  of  the  system 
which  were  most  catenated  with  the  new  motions  of  the  skin, 
as  the  stomach,  whence  indigestion  and  flatulency;  or  which 
are  generally  most  liable  to  fall  into  torpor,  as  the  numerous 
glands,  which  form  the  liver.  Whence  the  diseases  consequent 
to  the  hasty  cure  of  the  itch  are  diseases  of  debility,  as  tumid  vis- 
cera, cedematous  swellings,  and  St.  Vitus’s  dance,  which  is  a 
debility  of  association.  In  the  same  manner  indigestion,  with 
green  evacuations,  are  said  to  follow  an  injudicious  application 
of  cerussa  to  stop  too  hastily  the  exsudation  behind  the  ears  of 
children,  Class  I.  1.2.  9.  And  dropsies  are  liable  to  succeed 
the  cure  of  cold  ulcers  of  the  legs,  which  have  long  stimulated 
the  system. 

M.  M.  The  size  of  a large  pea,  of  an  ointment  consisting  of 
one  part  of  white  precipitate  of  mercury,  to  six  parts  of  hog's 
lard  well  triturated  together,  to  be  rubbed  on  a part  of  the  bod' 


Class  II.  1.  5.7. 


OF  SENSATION. 


237 


every  night,  and  washed  off  with  soap  and  water  next  morning, 
till  every  part  is  cleared;  with  lac  sulphuris  twenty  grains  to  be 
taken  every  morning  inwardly.  Warm  saline  bath,  with  white 
vitriol  in  it.  Flowers  of  sulphur  mixed  with  thick  gruel,  or 
with  hog’s  fat.  With  either  of  which  the  body  may  be  smeared 
all  over. 

Mr.  Grille  says,  that  those  who  get  manganese  from  its  mines 
are  not  subject  to  the  itch;  and  that  he  found  an  ointment,  com- 
posed of  six  parts  of  finely  levigated  manganese  and  of  sixteen 
parts  of  lard,  a more  efficacious  remedy  for  the  itch  than  those 
in  common  use.  Parmentier. 

7.  Psora  ebriorum.  Elderly  people,  who  have  been  much  ad- 
dicted to  spirituous  drinks,  as  beer,  wine,  or  alcohol,  are  liable 
to  an  eruption  all  over  their  bodies;  which  is  attended  with 
very  afflicting  itching,  and  which  they  probably  propagate 
from  one  part  of  their  bodies  to  another  with  their  own  nails  by 
scratching  themselves.  I saw  fatal  effects  in  one  such  patient, 
by  a too  extensive  use  of  a solution  of  lead;  the  eruption  disap- 
peared, he  became  dropsical  and  died;  I suppose  from  the  too 
suddenly  ceasing  of  the  great  stimulus  caused  by  the  eruptions 
over  the  whole  skin,  as  in  the  preceding  article. 

M.  M.  The  patient  should  gradually  accustom  himself  to  half 
his  usual  quantity  of  vinous  potation.  The  warm  bath,  with  one 
pound  of  salt  to  every  three  gallons.  Mercurial  ointments  on 
small  parts  of  the  skin  at  a time.  A grain  of  opium  at  night 
instead  of  the  usual  potation  of  wine  or  beer. 

8.  Herpes.  Herpes  consists  of  gregarious  spreading  excoria- 
tions, which  are  succeeded  by  branny  scales  or  scabs.  In  this 
disease  there  appears  to  be  a deficient  absorption  of  the  subcuta- 
neous mucus,  as  well  as  inflammation  and  increased  secretion  of 
it.  For  the  fluid  not  only  excoriates  the  parts  in  its  vicinity  by 
its  acrimony,  but  is  very  saline  to  the  taste,  as  some  of  these  pa- 
tients have  assured  me;  I believe  this  kind  of  eruption,  as  well 
as  the  tinea,  and  perhaps  all  other  cutaneous  eruption,  is  liable  to 
be  inoculated  in  other  parts  of  the  body  by  the  finger  nails  of  the 
patients  in  scratching  themselves. 

It  is  liable  to  effect  the  hands,  and  to  return  at  distant  periods; 
and  is  probably  a secondary  disease,  as  well  as  the  zona  ignea,  or 
shingles,  described  below. 

M.  M.  Poultice  the  eruption  with  bread  and  milk,  or  raw 
carrots  grated,  for  two  or  three  whole  days,  to  dilute  or  receive 
the  discharged  fluid,  and  abate  the  inflammation;  then  cover  the 
parts  with  fresh  cerate  mixed  with  lapis  calaminaris.  On  the 
parts  not  excoriated  mercurial  ointment,  made  of  one  part  of 
white  calx  of  mercury  and  six  of  hog’s  fat.  Internally,  after  vene- 


238 


DISEASES 


Class  II.  1 3.  9. 


section,  gentle  repeated  cathartics.  Lastly,  the  bark.  Acid  of 
vitriol.  Bolus  Armeniae,  or  testacea.  Antimonials.  Decoc- 
tion of  interior  bark  of  elm. 

9.  Zona  ignea.  Shingles.  This  eruption  has  been  thought  a 
species  of  herpes  by  some  writers,  and  by  others  a species  of 
erysipelas.  Yellow  or  livid  vesicles  appear,  producing  a corrosive 
ichor,  which  is  sometimes  attended  with  a degree  of  fever.  It 
is  said  to  infest  sometimes  the  thorax  and  ribs,  but  its  most  ge- 
neral situation  is  on  the  small  of  the  back,  over  one  kidney,  ex- 
tending forward  over  the  course  of  one  of  the  ureters. 

There  is  reason  to  suspect,  that  this  also  is  a secondary  or  sym- 
pathetic disease,  as  well  as  the  preceding  one;  but  future 
observations  are  required,  before  it  can  be  removed  to  the  fourth 
class,  or  diseases  of  association.  In  three  patients,  I have  been 
induced  to  believe,  that  the  eruption  on  the  loins  was  a transla- 
tion of  inflammation  from  the  external  membrane  of  the  kidney 
to  the  skin.  They  had  for  a day  or  two  before  the  appearance 
of  the  eruption,  complained  of  a dull  pain  on  the  region  of  one 
kidney,  but  without  vomiting;  by  which  it  was  distinguished 
from  nephritis  interna,  or  gravel;  and  without  pain  down  the 
outside  of  the  thigh,  by  which  it  was  distinguished  from  sciatica. 
In  other  situations  the  shingles  may  sympathize  with  other  inter- 
nal membranes,  as  in  a case  published  by  Dr.  Russel  (De  Tabe 
Glandulari),  where  the  retrocession  of  the  shingles  was  succeed- 
ed by  a serious  dyspnoea. 

M.  M.  Venesection,  if  the  pulse  is  strong.  Calomel  three  or 
four  grains,  very  mild  repeated  cathartics.  Poultice  for  a few 
days,  then  cerate  of  lapis  calaminaris,  as  in  herpes.  A grain  of 
emetic  tartar  dissolved  in  a pint  of  water,  and  taken  so  as  to  empty 
the  stomach  and  intestines,  is  said  much  to  hasten  the  cure; 
compresses  soaked  in  a saturnine  solution  are  recommended  ex- 
ternally on  the  eruption;  and  cerate  where  there  are  ulcerations. 
Desanet’s  Surgical  Journal,  Vol.  II.  p.  378.  If  this  be  a vicari- 
ous disease,  it  should  continue  half  a lunation;  lest,  on  its  ceas- 
ing, the  bad  habits  of  motion  of  the  primary  disease  should  not 
have  been  so  perfectly  dissevered,  but  that  they  may  recur. 

10.  Annulus  repens.  Ring-worm.  A prurient  eruption 
formed  in  a circle,  affecting  children,  and  would  seem  to  be  the 
work  of  insects,  according  to  the  theory  of  Linnaeus,  who  ascribes 
the  itch  and  dysentery  to  microscopic  animalcula.  These  ani- 
malcula  are  probably  the  effect,  and  not  the  cause,  of  these  erup- 
tions; as  they  are  to  be  seen  in  all  putrescent  animal  fluids.  The 
annular  propagation  of  the  ring-worm,  and  its  continuing  to  en- 
large its  periphery,  is  well  accounted  for  by  the  acrimony  of  the 
ichor  or  saline  fluid  eroding  the  skin  in  its  vicinity. 


Class  II.  1.5.  11. 


OF  SENSATIONS 


239 


M.  M.  Cover  the  eruption  daily  with  ink.  With  white  mer- 
curial ointment,  as  described  above  in  herpes.  With  solution  of 
white  vitriol  ten  grains  to  an  ounce.  These  metallic  calces  sti- 
mulate the  absorbents  into  stronger  action,  whence  the  fluid  has 
its  saline  part  reabsorbed,  and  that  before  it  has  access  to  the  air, 
which  probably  adds  to  its  acrimony  by  oxygenating  it,  and  thus 
producing  a new  acid. 

11.  Tinea.  Scald  head.  This  contagious  eruption  affects  the 
roots  of  the  hair,  and  is  generally  most  virulent  round  the  edges 
of  the  hair  on  the  back  part  of  the  head;  as  the  corona  veneris 
appears  most  on  the  edges  of  the  hair  on  the  fore  part  of  the  head: 
for  in  these  parts  the  eruption  about  the  roots  of  the  hair  is  most 
exposed  to  the  external  air,  by  which  its  acrimony  or  noxious 
quality  is  increased. 

The  absorption  of  the  matter  thus  oxygenated  swells  the  lym- 
phatics of  the  neck  by  its  stimulus,  occasioning  many  little  hard 
lumps  beneath  the  seat  of  the  eruption;  when  this  happens,  the 
sooner  it  is  cured  the  better,  lest  the  larger  lymphatics  of  the 
neck  should  become  affected. 

M.  M.  The  art  of  curing  these  eruptions  consists,  first,  in  abat- 
ing the  inflammation,  and  consequent  secretion  of  a noxious  mate- 
rial. Secondly,  in  preventing  its  access  to  the  air,  which  so  much 
increases  its  acrimony.  And  thirdly,  in  promoting  the  absorption 
of  it,  before  it  has  been  exposed  to  the  air.  For  these  purposes 
venesection  once,  and  gentle  cathartics,  which  promote  absorption 
by  emptying  the  blood-vessels.  Next  poultices  and  fomentations, 
with  warm  water,  abate  inflammation  by  diluting  the  saline  acri- 
mony of  the  secreted  fluid,  and  abating  the  painful  sensation. 
Afterwards  cerate  joined  with  some  metallic  calx,  as  of  zinc  or 
lead,  or  solution  of  lead,  mercury,  or  copper,  or  iron,  which  may 
stimulate  the  absorbent  system  into  stronger  action. 

Cover  the  shaved  head  with  tar  and  suet,  and  a bladder;  this, 
by  keeping  the  air  from  the  secreted  fluid,  much  contributes  to 
its  mildness,  and  the  stimulus  of  the  tar  increases  its  absorption. 
See  the  three  preceding  species  of  this  genus. 

Mr.  Morison  of  Dublin  cures  the  tinea  capitis  by  what  he  terms 
an  adhesive  paste,  which  is  made  by  boiling  half  a pound  of  fine 
flour  in  two  pounds  of  common  ale,  and  then  adding  four  ounces 
of  yellow  resin  in  fine  powder,  and  stirring  them  well  together, 
until  they  are  perfectly  incorporated.  After  removing  the  hair, 
and  poulticing  the  head  for  a day  or  two,  to  take  off  the  hard 
scabs,  this  paste  is  spread  on  slips  of  linen,  which  are  applied 
over  the  whole  affected  part,  and  removed,  and  fresh  ones  applied 
every  morning;  after  one  or  two  days,  I suspect,  that  removing 
the  plasters  seldomer  might  be  more  advantageous. 


240 


DISEASES 


Class  II.  1.  5. 12. 


12.  Crusta  lactea.  Milk-crust  is  a milder  disease  than  tinea, 
affeting  the  face  as  well  as  the  hairy  scalp  of  very  young  children. 
It  is  not  infectious,  nor  liable  to  swell  the  lymphatics  in  its  vici- 
nity like  the  tinea. 

M.  M.  Cover  the  eruption  with  cerate  made  with  lapis  cala- 
minaris,  to  be  renewed  every  day.  Mix  one  grain  of  emetic  tar- 
tar with  forty  grains  of  chalk,  and  divide  into  eight  papers,  one  to 
be  taken  twice  a day,  or  with  magnesia  alba,  if  stools  are  wanted. 
The  child  should  be  kept  cool  and  much  in  the  air. 

13.  Trichoma.  Plica  polonica.  A contagious  disease,  in  which 
the  hair  is  said  to  become  alive  and  bleed,  forming  inextricable 
knots  or  plaits  of  great  length,  like  the  fabled  head  of  Medusa, 
with  intolerable  pain,  so  as  to  confine  the  sufferer  on  his  bed  for 
years. 


Cuss  IT.  1.  6.1. 


OF  SENSATION. 


241 


ORDO  I. 

Increased  Sensation, 

GENUS  VI. 

With  Fever  consequent  to  the  Production  of  new  Vessels  or  Fluids- 
SPECIES. 

1 . Febris  sensitiva.  Sensitive  fever,  when  unmixed  with  either 
irritative  or  inirritative  fever,  may  be  distinguished  from  either 
of  them  by  the  less  comparative  diminution  of  muscular  strength; 
or  in  other  words,  from  its  being  attended  with  less  diminution 
of  the  sensorial  power  of  irritation.  An  example  of  unmixed 
sensitive  fever  may  generally  be  taken  from  the  pulmonary  con- 
sumption;  in  this  disease  patients  are  seen  to  walk  about  with 
ease,  and  to  do  all  the  common  offices  of  life  for  weeks,  and 
even  months,  with  a pulse  of  120  strokes  in  a minute;  while 
in  other  fevers,  whether  irritated  or  inirritated,  with  a pulse  of 
this  frequency,  the  patient  generally  lies  upon  the  bed  and 
exerts  no  muscular  efforts  without  difficulty. 

The  cause  of  this  curious  phenomenon  is  thus  to  be  under- 
stood; in  the  sensitive  fever  a new  sensorial  power,  viz.  that  of 
sensation  is  superadded  to  that  of  irritation;  which  in  other  fevers 
alone  carries  on  the  increased  circulation.  Whence  the  power 
of  irritation  is  not  much  more  exhausted  than  in  health;  and 
those  muscular  motions,  which  are  produced  in  consequence  of 
it,  as  those  which  are  exerted  in  keeping  the  body  upright  in 
walking,  riding,  and  in  the  performance  of  many  customary  ac- 
tions, .ire  little  impaired.  For  an  account  of  the  irritated  sensi- 
tive fever,  see  Class  II.  1.  2.  1.  ; for  the  inirritative  sensitive 
fever,  Class  II.  1.3.  1.  IV.  2.  4.  11. 

2.  Febris  a pure  clauso.  Fever  from  enclosed  matter  is  gene- 
rally of  the  irritated  sensitive  kind,  and  continues  for  many  weeks, 
and  even  months,  after  the  abscess  is  formed;  but  is  distinguish- 
ed from  the  fever  from  aerated  matter  in  open  ulcers,  because 
there  are  seldom  any  night- sweats,  or  colliquative  diarrhoea  in 
this,  as  in  the  latter.  The  pulse  is  also  harder,  and  requires  oc- 
casional venesection,  and  cathartics,  to  abate  the  inflammatory 
fever;  which  is  liable  to  increase  again  every  three  or  four  days, 
till  at  length,  unless  the  matter  has  an  exit,  it  destroys  the  patient. 
In  this  fever  the  matter,  not  having  been  exposed  to  the  air,  has 
not  acquired  oxygenation;  in  which  a new  acid,  or  some  other 

VOL.  II.  i i 


DISEASES 


Class  II.  1.  6.  3, 


242 


noxious  property,  is  produced;  which  acts  like  contagion  on  the 
constitution  inducing  fever  fits,  called  hectic  fever,  which  termi- 
nate with  sweats  or  diarrhoea;  whereas  the  matter  in  the  closed 
abscess  is  either  not  absorbed,  or  does  not  so  affect  the  circula- 
tion as  to  produce  diurnal  or  hectic  fever-fiis;  but  the  stimulus 
of  the  abscess  excites  so  much  sensation  as  to  induce  perpetual 
pyrexia,  or  inflammatory  fever,  without  such  marked  remissions. 
Nevertheless  there  sometimes  is  no  fever  produced,  wh  n the 
matter  is  lodged  in  a part  of  little  sensibility,  as  in  the  liver;  yet 
a white  pus-like  sediment  in  those  cases  exists  I believe  general- 
ly in  the  urine,  with  occasional  wandering  pains  about  the  region 
of  the  liver  or  chest 

3.  Vomica.  An  abscess  in  the  lungs  is  sometimes  produced 
after  peripneumony,  the  cough  and  shortness  of  breath  continue 
in  less  degree,  with  difficulty  in  lying  on  the  well  side,  and  with 
sensitive  irritated  fever,  as  explained  in  the  preceding  article. 

The  occasional  increase  of  fever,  with  hard  pulse  and  sizy 
blood,  in  these  patients,  is  probably  owing  to  the  inflammation 
of  the  walls  of  the  vomica;  as  it  is  attended  with  difficulty  of 

breathing,  and  requires  venesection.  Mr.  B , a child  about 

seven  years  old,  lived  about  seven  weeks  in  this  situation,  with  a 
pulse  from  150  to  170  in  a minute,  without  sweats,  or  diarrhoea, 
or  sediment  in  his  water,  except  mucus  occasionally;  and  took 
sufficient  nourishment  during  the  whole  time.  The  blood  ta- 
ken was  always  covered  with  a strong  cupped  size,  and  on  his 
death  three  or  four  pints  of  matter  were  found  in  one  side  of  the 
chest;  which  had  probably,  but  lately,  been  effused  from  a 
vomica.  This  child  wTas  frequently  induced  to  swing,  both  in  a 
reciprocating  and  in  a rotatory  swing,  without  any  apparent  ab- 
sorption of  matter;  in  both  these  swdngs  he  expressed  pleasure, 
and  did  not  appear  to  be  vertiginous. 

M.  M.  Repeated  emetics.  Digitalis?  Perseverance  in  rota- 
tory swinging.  See  Class  II.  1.  6.  7. 

Mr.  I.  had  laboured  some  months  under  a vomica  after  a perip- 
neumony, he  was  at  length  taken  with  a catarrh,  which  was  in 
some  degree  endemic  in  March,  1795,  which  occasioned  him  to 
sneeze  much,  during  which  a copious  haemorrhage  from  the 
lungs  occurred,  and  he  spit  up  at  the  same  time  half  a pint  of 
very  fetid  matter,  and  recovered.  Hence  errhines  may  be  occa- 
sionally used  with  advantage. 

4 . Empyema.  When  the  matter  from  an  abscess  in  the  lungs 
finds  its  way  into  the  cavity  of  the  chest,  it  is  called  an  empye-. 
ma.  A servant  man,  after  a violent  peripneumony,  was  seized 
with  symptoms  of  empyema,  and  it  was  determined,  after  some 
•time,  to  perform  the  operation;  this  was  explained  to  him,  and 


Class  If.  1.  6.  o. 


OF  SENSATION. 


243 


the  usual  means  were  employed  by  his  friends  to  encourage  him, 
“ by  advising  him  not  to  be  afraid.”  By  which  good  advice  he 
conceived  so  much  fear,  that  he  ran  away  early  next  morning, 
and  returned  in  about  a week  quite  well.  Did  the  great  fear 
promote  the  absorption  of  the  matter,  like  the  sickness  occasioned 
by  digitalis  ? Fear  renders  the  external  skin  pale;  by  this  con- 
tinued decrease  of  the  action  of  the  absorbents  of  the  skin  might 
not  those  of  the  lungs  be  excited  into  greater  activity?  and  thus 
produce  increased  pulmonary  absorption  by  reverse  sympathy, 
as  it  produces  pale  urine,  and  even  stools,  by  direct  sympathy? 

M.  M.  Digitalis? 

5.  Febris  Mesentericci.  Fever  from  matter  formed  in  the  me- 
sentery is  probably  more  frequent  than  is  suspected.  It  commences 
with  pain  in  the  bowels,  with  irritated  sensitive  fever;  and 
continues  many  weeks,  and  even  months,  requiring  occasional 
venesection,  and  mild  cathartics;  till  at  length  the  continuance 
of  the  pyrexia,  or  inflammatory  fever,  destroys  the  patient.  This 
is  an  aiiection  of  the  lymphatic  glands,  and  properly  belongs  to 
scrolula;  but  as  the  matter  is  not  exposed  to  the  air,  no  hectic 
fever,  properly  so  called,  is  induced. 

6.  Febris  a pure  aerato.  Fever  from  aerated  matter.  A great 
collection  of  matter  often  continues  a long  time,  and  is  some- 
times totally  absorbed,  even  from  venereal  buboes,  without  pro- 
ducing any  disorder  in  the  arterial  system.  At  length,  if  it  be- 
comes putrid  by  its  delay,  and  one  part  of  the  matter  thus  be- 
comes aerated  by  the  air  given  out  by  the  other  part;  or  if  the 
ulcer  has  been  opened,  so  that  any  part  of  it  has  been  exposed 
to  the  air  for  but  one  day,  a hectic  fever  is  produced.  Whence 
the  utility  arises  of  opening  large  abscesses  by  setons,  as  in  that 
case  little  or  no  hectic  fever  is  induced;  because  the  matter  is 
squeezed  out  by  the  side  of  the  spongy  threads  of  cotton,  and 
little  or  no  air  is  admitted;  or  by  tapping  the  abscess  with  a 
trocar,  as  meu  ioned  in  ischias,  C ass  II.  1.  2.  18. 

In  this  fever  the  pulse  is  about  120  in  a minute,  and  its  access 
is  generally  in  an  evening,  and  sometimes  about  noon  also,  with 
sweats  or  purging  towards  morning,  or  urine  with  pus-like 
sediment:  and  the  patients  bear  this  fever  better  than  any  other 
with  so  quick  a pulse:  and  lastly,  when  all  the  matter  from  a 
concealed  ulcer  is  absorbed,  or  when  an  open  ulcer  is  healed,  the 
hectic  fever  ceases.  Here  the  absorbed  matter  is  supposed  to 
pioduce  the  fever,  and  the  diarrhoea,  sweats,  or  copious  muddy 
urine,  to  be  simply  the  consequence  of  increased  secretion,  and 
not  to  consist  of  the  purulent  matter,  which  was  supposed  to  be 
absorbed  from  the  ulcer.  See  Sudor  calidus,  Class  I.  1.  2.  3. 

The  action  of  the  air  on  ulcers,  as  we  have  already  shewn,  in- 


244 


DISEASES 


Class  II.  1.  6.  G. 


creases  the  acrimony  of  the  purulent  matter,  and  even  converts 
it  into  a weaker  kind  of  contagious  matter;  that  is,  to  a mate- 
rial inducing  fever.  This  was  ascribed  to  the  union  of  the  azotic- 
part  of  the  atmosphere  with  the  effused  pus  in  Sect.  XXVIII.  2 
but  by  contemplating  more  numerous  facts  and  analogies.  I am 
now  induced  to  believe,  that  it  is  by  the  union  of  oxygen  with  it; 
first,  because  oxygen  so  greedily  unites  with  other  animal  substan- 
ces, as  the  blood,  that  it  will  passthrough  a moist  bladder  to  com- 
bine with  it,  according  to  the  experiment  of  Dr.  Priestley.  Se- 
condly, because  the  poisons  of  venomous  creatures  are  supposed 
to  be  acids  of  different  kinds,  and  are  probably  formed  by  the 
contact  of  air  after  their  secretion.  And  lastly,  because  the  con- 
tagious matter  from  other  ulcers,  as  in  itch,  or  small-pox,  is  form- 
ed on  external  membranes,  and  are  probably  combinations  of 
animal  matter  and  oxygen,  producing  other  new  acids. 

Since  having  written  the  above,  Dr.  Mitchell,  of  New-York, 
has  spoken  much  of  the  septic  quality  of  azote,  or  nitrogen;  and 
thinks  that  it  is  the  union  of  this  part  of  the  atmosphere  with 
the  matter  of  ulcers,  which  produces  or  increases  its  contagious 
or  fever-exciting  property;  which  I bad  myself  at  first  believed, 
as  mentioned  in  Part  I.  Sect.  XXVIII.  2.  In  support  of  this 
opinion,  it  may  be  said,  that  proper  ventilation  with  purer  air  is 
believed  certainly  to  diminish  or  destroy  infection;  as  spoken  of 
in  Class  II.  1.  3.  where  it  is  proposed  to  disengage  oxygen  from 
manganese,  for  the  purpose  of  purifying  crowded  apartments. 
But  further  experiments  must  determine  this  curious  inquiry; 
•which  might  be  attended  with  important  consequences,  if  azote, 
and  not  oxygen,  could  be  shewn  to  prevent  the  healing  of  pul- 
monary ulcers;  as  oxygen  might  be  respired  alone,  or  mixed 
with  hydrogen  or  with  carbonic  acid  gas,  instead  of  with  azote. 

It  was  thought  a subject  of  consequence  by  the  iEsculapian 
Society  at  Edinburgh,  to  find  a criterion  which  should  distin- 
guish pus  from  mucus,  for  the  purpose  of  more  certainly  dis- 
covering the  presence  of  ulcers  in  pulmonary  diseases,  or  in 
the  urinary  passages.  For  this  purpose  that  society  offered 
their  first  gold  medal,  which  was  conferred  on  the  late  Mr. 
Charles  Darwin,  in  the  year  1778,  for  his  experiments  on  this 
subject.  From  which  he  deduces  the  following  conclusions  : 

“ 1.  Pus  and  mucus  are  both  soluble  in  the  vitriolic  acid, 
though  in  very  different  proportions,  pus  being  much  the  less 
soluble. 

“ 2.  The  addition  of  water  to  either  of  these  compounds  de- 
composes it;  the  mucus  thus  separated,  either  swims  on  the  mix- 
ture, or  forms  large  flocci  in  it;  whereas  the  pus  falls  to  the 
bottom,  and  forms  on  agitation  a uniform  turbid  mixture 


Class  If,  1.  6.  7. 


OP  SENSATIONS 


245 


“ 3.  Pus  is  diffusible  through  a diluted  vitriolic  acid,  though 
mucus  is  not;  the  same  occurs  with  water,  or  a solution  of  sea 
salt. 

“ 4.  Nitrous  acid  dissolves  both  pus  and  mucus;  water  added 
to  the  solution  of  pus  produces  a precipitate;  and  the  fluid  above 
becomes  clear  and  green;  while  water  and  the  solution  of  mucus 
form  a dirty  coloured  fluid. 

“ 5.  Alkaline  lixivium  dissolves  (though  sometimes  with  diffi- 
culty) mucus,  and  generally  pus. 

“ 6.  Water  precipitates  pus  from  such  a solution,  but  does  not 
mucus. 

“ 7.  Where  alkaline  lixivium  does  not  dissolve  pus,  it  still  dis- 
tinguishes it  from  mucus;  as  it  then  prevents  its  diffusion  through 
water. 

“ 8.  Coagulable  lymph  is  neither  soluble  in  diluted  nor  con- 
centrated vitrolic  acid. 

“ 9.  Water  produces  no  change  on  a solution  of  serum  in  al- 
kaline lixivium,  until  after  long  standing,  and  then  only  a very 
slight  sediment  appears. 

“ 10.  Corrosive  sublimate  coagulates  mucus,  hut  not  pus. 

“ From  the  above  experiments  it  appears,  that  strong  vitri- 
olic acid  and  water,  diluted  vitriolic  acid,  and  caustic  alkaline 
lixivium  and  water,  will  serve  to  distinguish  pus  from  mucus; 
that  the  vitriolic  acid  can  separate  it  from  coagulable  lymph,  and 
alkaline  lixivium  from  serum. 

“ And  hence,  when  a person  has  any  expectorated  material, 
the  composition  of  which  he  wishes  to  ascertain,  let  him  dissolve 
it  in  vitriolic  acid,  and  in  caustic  alkaline  lixivium;  and  then 
add  pure  water  to  both  solutions,  and  if  there  is  a fair  precipi- 
tation in  each,  he  may  be  assured  that  some  pus  is  present.  If 
in  neither  a precipitation  occurs,  it  is  a certain  test,  that  the 
material  is  entirely  mucus.  If  the  material  cannot  be  made  to 
dissolve  in  alkaline  lixivium  by  time  and  trituration,  we  have 
also  reason  to  believe  that  it  is  pus.”  Experiments  on  Pus  and 
Mucus.  Cadell.  London. 

Dr.  Cappe,  of  York,  in  bis  inaugural  treatise  de  Hectica,  and 
Dr.  Ryan,  of  Dublin,  in  his  Essay  on  Consumption,  have  repeat- 
ed these  experiments  of  Mr.  Darwin  with  nearly  similar  results. 

7.  Phthisis pulmonalis.  In  pulmonary  consumption  the  fever 
is  generally  supposed  to  be  the  consequence  of  the  stimulus  of 
absorbed  matter  circulating  in  the  blood-vessels,  and  not  simply 
of  its  stimulus  on  their  extremities  in  the  surface  of  the  ulcers; 
as  mentioned  in  Class  II.  1.  5.  and  Class  13.  I.  3.  9.  The  ul- 
cers are  probably  sometimes  occasioned  by  the  putrid  acrimony 
of  effused  blood  remaining  in  the  air-cells  of  the  lungs  after  an 


246 


DISEASES 


Class  II.  1. 6.  7. 


baemaptoe.  See  Class  I.  2.  1.  9.  The  remote  cause  of  con- 
sumption is  ingeniously  ascribed  by  Dr.  Beddoes  to  the  ii.jper- 
oxygenation  of  the  blood,  as  mentioned  Section  XXVlli.  2. 

As  the  patients  liable  to  consumption  are  oi  me  inimiable 
temperament,  as  appears  by  the  large  pupils  of  their  eyes;  there 
is  reason  to  believe,  that  the  haemoptoe  is  immediately  occasion- 
ed by  the  deficient  absorption  of  the  blood  at  the  extremities  of 
the  bronchial  vein;  and  that  one  difficulty  of  healing  tne  metis 
is  occasioned  by  the  deficient  absorption  oi  the  lluids  effused  in- 
to them.  See  Sect.  XXX.  1.  and  2. 

The  difficulty  of  healing  pulmonary  ulcers  may  be  owing,  as 
its  remote  cause,  to  the  incessant  motion  of  all  tne  parts  of  the 
lungs;  whence  no  scab,  or  indurated  mucus,  can  be  formed  so 
as  to  adhere  on  them.  Whence  these  naked  ulcers  are  perpe- 
tually exposed  to  the  action  of  the  air  on  their  surfaces,  convert- 
ing their  mild  purulent  matter  into  a contagious  ichor;  winch 
not  only  prevents  them  from  healing,  but  by  its  action  on  their 
circumferences,  like  the  matter  of  itch  or  tinea,  contributes  to 
spread  them  wider.  See  the  preceding  article,  anti  Sect.  XXXill. 
2.  7.  where  the  pulmonary  phthisis  is  supposed  to  be  infectious. 

This  acidifying  principle  is  found  in  aii  the  metallic  calces, 
as  in  lapis  calaminaris,  which  is  a calciiorm  ore  of  zinc; 
and  in  minium,  which  is  a calx  of  lead;  two  materials 
which  are  powerful  in  healing  excoriations  and  ulcers,  in  a 
short  time,  by  their  external  application.  How  then  uoes  it 
happen,  that  the  oxygen  in  the  atmosphere  should  prevent  pul- 
monary ulcers  from  healing,  and  even  induce  them  to  spread 
wider;  and  yet  !n  its  combination  with  metals,  it  should  iaciii- 
tate  their  healing?  The  healing  of  ulcers  consists  in  promoting 
the  absorption  of  the  fluids  effused  into  them,  as  treated  ot  in 
Section  XXXUI.  3.  2.  Oxygen  in  combination  with  metals, 
when  applied  in  certain  quantity,  produces  this  effect  by  its 
stimulus;  and  the  metallic  oxides  not  being  decomposed  by 
their  contact  with  animal  matter,  no  new  acid,  or  contagious 
material,  is  produced.  So  that  the  combined  oxygen  when  ap- 
plied to  an  ulcer,  simply  I supjiose  promotes  absorption  in  it, 
like  the  application  of  other  materials  of  the  articles  sorbentia  or 
incitantia,  if  applied  externally;  as  opium,  bark,  alum.  But 
in  the  pulmonary  ulcers  which  cannot  protect  themselves  from 
the  air  by  forming  a scab,  the  uncombined  oxygen  of  the  atmo- 
sphere unites  with  the  purulent  matter,  converting  it  into  a con- 
tagious ichor;  which,  by  infection,  not  by  erosion,  enlarges 
the  ulcers,  as  in  the  itch  or  tinea;  which  might  hence,  accord- 
ing to  Dr.  Beddoes‘,s  ingenious  theory  of  consumption,  be  in- 
duced to  heal,  if  exposed  to  an  atmosphere  deprived  of  a part  of 


Class  II.  1.  6. 7. 


OF  SENSATION'. 


247 


its  oxygen.  This  I hope  future  experiments  will  confirm,  and 
that  the  pneumatic  medicine  will  alleviate  the  evils  of  mankind 
in  many  others,  as  well  as  in  this  most  fatal  malady. 

M.  M.  First,  the  respiration  of  air  lowered  by  an  additional 
quantity  of  azote,  or  mixed  with  some  proportion  of  hydrogen, 
or  of  carbonic  acid  air,  maybe  tried;  as  described  in  a late  pub- 
lication of  Dr.  Beddoes  on  the  medicinal  use  of  factitious  airs. 
Johnson,  London.  Or  lastly,  by  breathing  a mixture  of  one- 
tenth  part  of  hydrocarbonate  mixed  with  common  air,  according 
to  the  discovery  of  Mr.  Watt,  which  has  a double  advantage  in 
these  cases,  of  diluting  the  oxygen  of  the  atmospheric  air,  and 
inducing  sickness,  which  increases  pulmonary  absorption,  as 
mentioned  below.  An  atmosphere  diluted  with  fixed  air  (car- 
bonic acid)  might  be  readily  procured  by  setting  tubs  of  new 
wort,  or  fermenting  beer,  in  the  parlour  and  lodging-room  of 
the  patient.  'For  it  is  not  acids  floating  in  the  air,  but  the  oxygen 
or  acidifying  principle,  which  injures  or  enlarges  pulmonary  ul- 
cers by  combining  with  the  purulent  matter. 

Another  easy  method  of  adding  carbonic  acid  gas  to  the  air 
of  a room  would  be  by  means  of  an  apparatus  invented  by  Mr. 
Watt,  and  sold  by  Bolton  and  Watt,  at  Birmingham,  as  described 
in  Dr.  Beddoes’  Treatise  on  Pneumatic  Medicine.  Johnson, 
London.  It  consists  of  an  iron  pot,  with  an  arm  projecting,  and 
a method  of  letting  water  drop  by  slow  degrees  on  chalk,  which 
is  to  be  put  into  the  iron  pot,  and  exposed  to  a moderate  degree 
of  heat  over  a common  fire.  By  occasionally  adding  more  and 
more  chalk,  carbonic  acid  gas  might  be  carried  through  a tin  pipe 
from  the  arm  of  the  iron  pot  to  any  part  of  the  room  near  the 
patient,  or  from  an  adjoining  room.  In  the  same  manner  a dif- 
fusion of  solution  of  flowers  of  zinc  might  be  produced  and 
breathed  by  the  patient,  and  would  be  likely  much  to  contribute 
to  the  healing  of  pulmonary  ulcers;  as  observed  by  Mr.  Watt. 
See  the  treatise  above  mentioned. 

Breathing  over  the  vapour  of  caustic  volatile  alkali  might  easily 
be  managed  for  many  hours  in  a day;  which  might  neutralize  the 
acid  poison  formed  on  pulmonary  ulcers  by  the  contact  of  oxygen, 
and  thus  prevent  its  deleterious  quality,  as  other  acids  become  less 
caustic,  when  they  are  formed  into  neutral  salts  with  alkalies. 
The  volatile  salt  should  be  put  into  a tin  canister,  with  two  pipes 
like  horns  from  the  top  of  it,  one  to  suck  the  air  from,  and  the 
other  to  admit  it. 

Secondly,  the  external  ulcers  in  scrofulous  habits  are  pale  and 
flabby,  and  naturally  disinclined  to  heal,  the  deposition  of  fluids 
in  them  being  greater  than  the  absorption;  these  ulcers  have 
their  appearance  immediately  changed  by  the  external  application 


248 


DISEASBS 


Class  II.  1.  6.  7. 


of  metallic  calxes,  and  the  medicines  of  tire  article  Sorbentia, 
such  as  cerussa  and  the  bark  in  fine  powder,  see  Class  I.  2 3 21. 
and  are  generally  healed  in  a short  time  by  these  means.  Induced 
by  these  observations,  I wished  to  try  the  external  application  of 
such  powders  to  ulcers  in  the  lungs,  and  constructed  a box  with 
a circulating  brush  in  it!  Into  this  box  two  ounces  of  fine  powder 
of  Peruvian  bark  were  put,  and  two  drachms  of  cerussa  in  fine 
powder;  on  whirling  the  central  brush,  part  of  this  was  raised  in- 
to a cloud  of  powder,  and  the  patient,  applying  his  mouth  to  one 
of  the  tin  pipes  rising  out  of  the  box,  inhaled  this  powder  twice  a 
day  into  his  lungs.  I observed  it  did  not  produce  any  cough  or 
uneasiness.  This  patient  was  in  the  last  stage  of  consumption, 
and  was  soon  tired  of  the  experiment,  nor  have  I had  such  patients 
as  I wished  for  the  repetition  of  it.  Perhaps  a fine  powder  of 
manganese,  or  of  the  flowers  of  zinc,  or  of  lapis  calaminaris, 
might  be  thus  applied  to  ulcers  of  the  lungs  with  greater  advan- 
tage? Perhaps  air  impregnated  With  flowers  of  zinc  in  their  most 
comminuted  state,  might  be  a better  way  of  applying  this  powder 
to  the  lungs,  as  discovered  by  Mr.  Watt.  See  Dr.  Beddoes  on 
Pneumatic  Medicine.  Johnson. 

Thirdly,  as  the  healing  of  an  ulcer  consists  in  producing  a 
tendency  to  absorption  on  its  surface  greater  than  the  deposition 
cn  it;  see  Sect.  XXXIII.  3.  2.;  other  modes  of  increasing  pul- 
monary absorption,  which  are  perhaps  more  manageable  than 
the  preceding  ones,  may  be  had  recourse  to;  such  as  by  pro- 
ducing frequent  nausea  or  sickness.  See  Sect.  XXIX.  5.  1.  and 
Art.  IV.  2,  The  great  and  sudden  absorption  of  fluid  from  the 
lungs  in  the  anasarca  pulmonum  by  the  sickness  induced  bv  the 
exhibition  of  digitalis,  astonishes  those  who  have  not  before  at- 
tended to  it,  by  emptying  the  swelled  limbs,  and  removing  the 
difficulty  of  breathing  in  a few  hours. 

The  most  manageable  method  of  using  digitalis  is  by  making 
a saturated  tincture  of  it,  by  infusing  two  ounces  of  the  powder 
of  the  leaves  in  a mixture  of  four  ounces  of  rectified  spirit  of 
wine,  and  four  ounces  of  water.  Of  this  from  30  to  60  drops,  or 
upwards,  from  a two-ounce  phial,  are  to  be  taken  twice  in  the 
morning  part  of  the  day,  and  to  be  so  managed  as  not  to  induce 
violent  sickness.  If  sickness  nevertheless  comes  on,  the  patient 
must  for  a day  or  two  omit  the  medicine;  and  then  begin  it  again 
in  reduced  doses. 

Mr. , a young  man  about  twenty,  with  dark  eyes  and 

large  pupils,  who  had  every  symptom  of  pulmonary  ulcers,  I 
believed  to  have  been  cured  by  digitalis,  and  published  the  case 
in  the  Transactions  of  the  College,  Vol.  III.  But  I heard 
that  about  two  years  afterwards  he  relapsed  and  died.  Mr 


Class  II.  1.  6,  7. 


OF  SENSATION. 


249 


L , a corpulent  man,  who  had  for  some  weeks  laboured 

under  a cough  with  great  expectoration,  with  quick  pulse,  and 
difficulty  of  breathing,  soon  recovered  by  the  use  of  digitalis 
taken  twice  a day;  and  though  this  case  might  probably  be  a 
peripneumonia  notha,  or  catarrh,  it  is  here  related  as  shewing 
the  power  of  pulmonary  absorption  excited  by  the  use  of  this 
drug. 

Since  the  publication  of  the  above,  some  successful  cases  of., 
the  treatment  of  consumption  by  the  tincture  of  digitalis  are  re- 
lated in  Medical  and  Physical  Contributions,  edited  by  Dr.  Bed- 
does.  Longman,  London.  Two  of  the  successful  cases  are  from 
Dr.  Drake,  who  observes,  “ that  by  gradually  increasing  the  dose 
of  the  saturated  tincture  of  digitalis  from  20  drops  to  100  twice 
a day,  all  the  symptoms  of  fever,  cough,  pain,  and  dyspnoea,  daily 
grew  better,  and  at  length  totally  ceased,  and  that  on  the  quan- 
tity and  quality  of  the  expectorated  matter,  the  digitalis  soon  ex- 
erted a very  remarkable  effect,  either  promoting  its  absorption, 
or  diminishing  its  secretion,  or  perhaps  both,  in  a rapid  manner; 
while  at  the  same  time  it  deprived  it  of  its  fetor.”  Many  cases 
with  great  relief,  or  with  prosperous  event,  are  related  by  Dr. 
Fowler,  and  bv  Dr.  Beddoes.  One  I have  also  lately  seen  my- 
self, whom  I believed  to  be  consumptive,  and  who  is  of  a con- 
sumptive family,  and  after  having  used  the  saturated  tincture 
about  six  weeks,  or  two  months,  in  various  doses,  is  now  believed 
by  herself  and  friends  to  be  perfectly  restored  to  health,  but  there 
has  not  been  time  enough  yet  elapsed  to  determine,  whether  she 
may  not  relapse,  now  she  discontinues  the  medicine. 

Nevertheless,  as  the  digitalis  has  been  given  in  many  cases 
without  success,  there  is  reason  to  believe,  that  it  should  be  taken 
early  in  the  disease,  before  too  great  ulcerations  are  produced, 
and  too  great  debility  exists.  As  these  patients  are  subject  to 
flatter  themselves  more  than  most  others,  and  are  liable,  on  that 
account,  not  to  apply  soon  enough  for  proper  assistance,  they 
should  be  warned  that  a cough  attended  with  a pulse  that  beats 
120  times  in  a minute,  is  always  a disease  of  danger. 

Another  method  of  inducing  sickness,  and  pulmonary  absorp- 
tion in  consequence,  is  by  sailing  on  the  sea;  by  which  many 
consumptive  patients  have  been  said  to  have  received  their  cure; 
which  has  been  erroneously  ascribed  to  sea-air,  instead  of  sea- 
sickness; whence  many  have  been  sent  to  breathe  the  sea-air  on 
the  coasts,  who  might  have  done  better  in  higher  situations,  where 
the  air  probably  contains  less  oxygen  gas,  which  is  the  heaviest 
part  of  it.  See  a letter  from  Dr.  J.  C.  below. 

A third  method  of  inducing  sickness,  and  consequent  pulmo- 
nary absorption,  is  by  the  vertigo  occasioned  by  swinging;  which 

VOL.  IX.  K k 


250 


DISEASES 


Class  II.  1.  6.  7”. 


lias  lately  been  introduced  into  practice  by  Dr.  Smith,  (Essay  on 
Pulmonary  Consumption,)  who  observed  that  by  swinging  the 
hectic  pulse  became  slower,  which  is  explained  in  Class  IV.  2. 
1.  10.  The  usual  way  of  reciprocating  swinging,  like  the  oscil- 
lations of  a pendulum,  produces  a degree  of  vertigo  in  those, 
who  are  unused  to  it;  but  to  give  it  greater  effect,  the  patient 
should  be  placed  in  a chair  suspended  from  the  ceiling  by  uvo 
parallel  cords  in  contact  with  each  other,  the  chair  should  then 
be  forcibly  revolved  20  or  40  times  one  way,  and  suffered  to  re- 
turn spontaneously;  which  induces  a degree  of  sickness  in  most 
adult  people,  and  is  well  wTorthy  an  exact  and  pertinacious  trial, 
for  an  hour  or  two,  three  or  four  times  a day  for  a month. 

The  common  means  of  promoting  absorption  in  ulcers,  and 
of  thickening  the  matter  in  consequence,  by  taking  the  bark  and 
opium  internally,  or  by  metallic  salts,  as  of  mercury,  steel, 
zinc,  and  copper,  in  small  quantities,  have  been  repeatedly  used 
in  pulmonary  consumption;  and  may  have  relieved  some  of 
the  symptoms.  As  mercury  cures  venereal  ulcers,  and  as  pul- 
monary ulcers  resemble  them  in  their  not  having  a disposition  to 
heal,  and  in  their  tendency  to  enlarge  themselves,  there  were 
hopes,  from  analogy,  that  it  might  have  succeeded.  Would  a 
solution  of  gold  in  aqua  regia  be  worth  trying?  When  vinegar 
is  applied  to  the  lips,  it  renders  them  instantly  pale,  by  promot- 
ing the  venous  absorption;  if  the  whole  skin  was  moistened  with 
warmish  vinegar,  would  this  promote  venous  absorption  in  the 
lungs  by  their  sympathy  with  the  skin?  The  very  abstemious 
diet  on  milk  and  vegetables  alone  is  frequently  injurious.  Flesh 
meat  once  a day,  with  small  wine  and  water,  or  small  beer,  is  pre- 
ferable. Half  a grain  of  opium  twice  a day,  or  a grain,  I believe 
to  be  of  great  use  at  the  commencement  of  the  disease,  as  ap- 
pears from  the  subsequent  case. 

Miss , a delicate  young  lady,  of  a consumptive  family, 

when  she  was  about  eighteen,  had  frequent  cough,  with  quick 
pulse,  a pain  of  her  side,  and  the  general  appearances  of  a be- 
ginning consumption.  She  took  about  five  drops  of  laudanum 
twice  a day  in  a saline  draught,  which  was  increased  gradually 
to  ten.  In  a few  weeks  she  recovered,  was  afterwards  married, 
bore  three  or  four  children,  and  then  became  consumptive  and 
died. 

The  following  case  of  hereditary  consumption  is  related  by  a 
physician  of  great  ability  and  very  extensive  practice;  and,  as 
it  is  his  own  case,  abounds  with  much  nice  observation  and  use- 
ful knowledge;  and,  as  it  has  been  attended  with  a favourable 
event,  may  give  consolation  to  many,  who  are  in  a similar  situa- 
tion; and  shews  that  Sydenham’s  recommendation  of  riding  as 


OF  SENSATION'. 


CiAss  II.  1.  6.  7. 


251 


a cure  for  consumption  is  not  so  totally  ineffectual,  as  is  now 
commonly  believed. 

J.  C.  aged  27,  with  black  hair,  and  a ruddy  complexion,  was 
subject  to  cough  from  the  age  of  puberty,  and  occasionally  to 
spitting  of  blood.  His  maternal  grandfather  died  of  consump- 
tion under  thirty  years  of  age,  and  his  mother  fell  a victim  to 
this  disease,  with  which  she  had  long  been  threatened,  in  her 
43d  year,  and  immediately  after  she  ceased  to  have  children.  In 
the  severe  winter  of  1783-4,  he  was  much  ajflicted  with  cough; 
and  being  exposed  to  intense  cold,  in  the'  month  of  February  he 
was  seized  with  peripneumony.  The  disease  was  violent  and 
dangerous,  and  after  repeated  bleedings  as  well  as  blisterings, 
which  he  supported  with  difficulty,  in  about  six  weeks  he  was 
able  to  leave  his  bed.  At  this  time  the  cough  was  severe,  and 
the  expectoration  difficult.  A fixed  pain  remained  on  the  left 
side,  where  an  issue  was  inserted;  regular  hectic  came  on  every 
day  about  an  hour  after  noon,  and  every  night  heat  and  restless- 
ness took  place,  succeeded  towards  morning  by  general  perspira- 
tion. 

The  patient,  having  formerly  been  subject  to  ague,  was  struck 
with  the  resemblance  of  the  febrile  paroxysm,  with  what  he  had 
experienced  under  that  disease,  and  was  willing  to  flatter  himself 
it  might  be  of  the  same  nature.  He  therefore  took  bark  in  the  in- 
terval of  fever,  but  with  an  increase  of  his  cough,  and  this  requir- 
ing venesection,  the  blood  was  found  highly  inflammatory.  The 
vast  quantity  of  blood  which  he  had  lost  from  time  to  time,  pro- 
duced a disposition  to  fainting,  when  he  resumed  the  upright  pos- 
ture, and  he  was  therefore  obliged  to  remain  almost  constantly  in 
a recumbent  position.  Attempting  to  ride  out  in  a carriage  he 
was  surprised  to  find  that  he  could  sit  upright  for  a considerable 
time,  while  in  motion,  without  inconvenience,  though  on  stopping 
the  carriage,  the  disposition  to  fainting  returned. 

At  this  time,  having  prolonged  his  ride  beyond  the  usual  length, 
he  one  day  got  into  an  uneven  road  at  the  usual  period  of  the  re- 
currence of  the  hectic  paroxysms,  and  that  day  he  missed  it  alto- 
gether. This  circumstance  led  him  to  ride  out  daily  in  a car- 
riage at  the  time  the  febrile  accession  might  be  expected,  and 
sometimes  by  this  means  it  was  prevented,  sometimes  deferred, 
and  almost  always  mitigated. 

This  experience  determined  him  to  undertake  a journey  of 
some  length,  and  Bristol  being,  as  is  usual  in  such  cases,  recom- 
mended, he  set  out  on  the  19th  of  April,  and  arrived  there  on 
the  2d  of  May.  During  the  greater  part  of  this  journey  (of  175 
miles)  his  cough  was  severe,  and  being  obliged  to  be  bled 
three  different  times  on  the  road,  he  was  no  longer  able  to  sit  up- 


252 


DISEASES 


Class  II.  1.  6.7. 


right,  but  a-t  very  short  intervals,  and  was  obliged  to  lie  at  length 
in  the  diagonal  of  a coach.  The  hectic  paroxysms  were  not  in- 
terrupted during  the  journey,  but  they  were  irregular  and  indis- 
tinct, and  the  salutary  effects  of  exercise,  or  rather  gestation 
were  impressed  on  the  patient’s  mind. 

At  Bristol  he  stayed  a month,  but  reaped  no  benefit.  The 
weather  was  dry  and  the  roads  dusty;  the  water  insipid  and  in- 
ert. He  attempted  to  ride  on  horseback  on  the  downs,  but  was 
not  able  to  bear  the  fatigue  for  a distance  of  more  than  a hundred 
yards.  The  necessity  of  frequent  bleedings  kept  down  his  strength, 
and  his  hectic  paroxysms  continued,  though  less  severe.  At 
this  time,  suspecting  that  his  cough  was  irritated  by  the  west 
winds  bearing  the  vapour  from  the  sea,  he  resolved  to  try  the  ef- 
fects of  an  inland  situation,  and  set  off  for  Matlock  in  Derbyshire. 

During  the  journey  he  did  not  find  the  improvement  he  ex- 
pected, but  the  nightly  perspirations  began  to  diminish;  and 
the  extraordinary  fatigue  he  experienced  proceeded  evidently 
from  his  travelling  in  a post-chaise,  where  he  could  not  indulge 
in  a recumbent  position.  The  weather  at  Bristol  had  been  hot, 
and  the  earth  arid  and  dusty.  At  Matlock,  during  the  month  of 
June  1784,  there  was  almost  a perpetual  drizzle,  the  soil  was 
wet,  and  the  air  moist  and  cold.  Here,  however,  the  patient's 
cough  began  to  abate,  and  at  intervals  he  found  an  opportunity 
of  riding  more  or  less  on  horseback.  From  two  or  three  hundred 
yards  at  a time,  he  got  to  ride  a mile  without  stopping;  and  at 
length  he  was  able  to  sit  on  horseback  during  a ride  from  Mason's 
Bath  to  the  village  of  Matlock  along  the  Derwent,  and  round  on 
the  opposite  banks,  by  the  works  of  Mr.  Arkwright,  back  to  the 
house  whence  he  started, a distance  of  five  miles.  On  dismounting, 
however,  he  was  seized  with  deliquium,  and  soon  after  the  strength 
he  had  recovered  was  lost  by  an  attack  of  the  haemorrhoids  of  the 
most  painful  kind,  and  requiring  much  loss  of  blood  from  the 
parts  affected. 

i On  reflection,  it  appeared  that  the  only  benefit  received  by 
the  patient  was  during  motion,  and  continued  motion  could  better 
be  obtained  in  the  course  of  a journey  than  during  his  residence 
at  any  particular  place.  This  and  other  circumstances  of 
a private  but  painful  nature,  determined  him  to  set  out  from 
Matlock  on  a journey  to  Scotland.  The  weather  was  now  much 
improved,  and  during  the  journey  he  recruited  his  strength. 
Though  as  yet  he  could  not  sit  upright  at  rest  for  half  an  hour 
together  without  a disposition  to  giddiness,  dimness  of  sight,  and 
deliquium,  he  was  able  to  sit  upright  under  the  motion  of  a post- 
chaise  during  a journey  of  from  40  to  70  miles  daily,  and  his 


Class  II.  1.  6.  7. 


OP  SENSATION. 


253 


appetite  began  to  improve.  Still  his  cough  continued,  and  his 
hectic  flushings,  though  the  chills  were  much  abated  and  very 
irregular. 

The  salutary  effects  of  motion  being  now  more  striking  than 
ever,  he  purchased  a horse  admirably  adapted  to  a valetudinarian 
in  Dumfriesshire,  and  being  now  able  to  sit  on  horseback  for  an 
hour  together,  he  rode  out  several  times  a day.  He  fixed  his 
residence  for  a few  weeks  at  Moffat,  a village  at  the  foot  of  the 
mountains  whence  the  Tweed,  the  Clyde.,  and  the  Annan,  de- 
scend in  different  directions;  a situation  inland,  dry  and  healthy, 
and  elevated  about  three  hundred  feet  above  the  surface  of  the 
sea.  Here  his  strength  recovered  daily,  and  he  began  to  eat  ani- 
mal food,  which  for  several  months  before  he  had  not  tasted. 
Persevering  in  exercise  on  horseback,  he  gradually  increased  the 
length  of  his  rides,  according  to  his  strength,  from  four  to  twenty 
miles  a day;  and  returning  on  horseback  to  Lancashire,  by  the 
lakes  of  Cumberland,  he  arrived  at  Liverpool  on  the  first  of  Sep- 
tember, having  rode  the  last  day  of  his  journey  forty  miles. 

The  two  inferences  of  most  importance  to  be  drawn  from  this 
narrative,  are,  first,  the  extraordinary  benefit  derived  from  gesta- 
tion in  a carriage,  and  still  more  the  mixture  of  gestation  and 
exercise  on  horseback,  in  arresting  or  mitigating  the  hectic  pa- 
roxysm; and  secondly,  that  in  the  florid  consumption,  as  Dr. 
Beddoes  terms  it,  an  elevated  and  inland  air  is  in  certain  circum- 
stances peculiarly  salutary;  while  an  atmosphere  loaded  with  the 
spray  of  the  sea  is  irritating  and  noxious.  The  vicinity  of  the. 
sea  appears  very  injurious  to  almost  all  vegetables,  and  should  on 
that  account  be  suspected  in  respect  to  its  general  salubrity,  though 
it  may  nevertheless  be  medicinal  in  some  diseases,  if  resorted  to 
for  a time  in  the  summer  months,  but  must  be  ineligible  as  a per- 
manent residence.  See  Class  I.  2.  1.  15. 

The  benefit  derived  in  this  case  from  exercise  on  horseback, 
may  lead  us  to  doubt  whether  Sydenham’s  praise  of  this  remedy 
be  as  much  exaggerated  as  it  has  of  late  been  supposed.  Since  the 
publication  of  Dr.  C.  Smith  on  the  effects  of  swinging  in  lower- 
ing the  pulse  in  the  hectic  paroxysm,  the  subject  of  this  narrative 
has  repeated  his  experiments  in  a great  variety  of  cases,  and  has 
confirmed  them.  He  has  also  repeatedly  seen  the  hectic  pa- 
roxysm prevented,  or  cut  short,  by  external  ablution  of  the  naked 
body  with  tepid  water. 

So  much  was  his  power  of  digestion  impaired  or  vitiated  by 
the  immense  evacuations,  and  the  long  continued  debility  he  un- 
derwent, that  after  the  cough  was  removed,  and  indeed  for  seve- 
ral years  after  the  period  mentioned,  he  never  could  eat  animal 
food  without  heat  and  flushing,  with  frequent  pulse  and  extreme 


254 


DISEASES 


Eiass  FT.  1.  6.  7. 


drowsiness.  If  this  drowsiness  was  encouraged,  the  fever  ran 
high,  and  he  awoke  from  disturbed  sleep,  wearied  and  depressed. 
If  it  was  resolutely  resisted  by  gentle  exercise,  it  went  off  in  about 
an  hour,  as  well  as  the  increased  frequency  of  the  pulse.  This 
agitation  was  however  such  as  to  incapacitate  him  during  the 
afternoon  for  study  of  any  kind.  The  same  effects  did  not  fol- 
low a meal  of  milk  and  vegetables,  but  under  this  diet  his  strength 
did  not  recruit;  whereas  after  the  use  of  animal  food  it  recovered 
rapidly,  notwithstanding  the  inconvenience  already  mentioned. 
For  this  inconvenience  he  at  last  found  a remedy  in  the  use  of 
coffee  immediately  after  dinner,  recommended  to  him  by  his 
friend  Dr.  Percival.  At  first  this  remedy  operated  like  a charm, 
but  by  frequent  use,  and  indeed  by  abuse,  it  no  longer  possesses 
its  original  efficacy. 

Dr.  Falconer,  in  his  Dissertation  on  the  Influence  of  the  Pas- 
sions and  Affections  of  the  Mind  on  Health  and  Disease,  sup- 
poses that  the  cheerfulness  which  attends  hectic  fever,  the  ever- 
springing  hope,  which  brightens  the  gloom  of  the  consumptive 
patient,  increases  the  diseased  actions,  and  hastens  his  doom. 
And  hence  he  is  led  to  inquire,  whether  the  influence  of  fear 
might  not  be  substituted  in  such  cases  to  that  of  hope  with  ad- 
vantage to  the  patient?  This  question  I shall  not  presume  to 
answer,  but  it  leads  me  to  say  something  of  the  state  of  the  mind 
in  the  case  just  related. 

The  patient,  being  a physician,  was  not  ignorant  of  his  dan- 
ger, which  some  melancholy  circumstances  served  to  impress 
on  his  mind.  It  has  already  been  mentioned,  that  his  mother 
and  grandfather  died  of  this  disease.  Ii  may  be  added,  that  in 
the  year  preceding  that  on  which  he  himself  tvas  attacked,  a 
sister  of  his  was  carried  off  by  consumption  in  her  17th  year; 
that  in  the  same  winter  in  which  he  fell  ill,  two  other  sisters 
were  seized  with  the  same  fatal  disorder,  to  which  one  of  them 
fell  a victim  during  his  residence  at  Bristol,  and  that  the  hope 
cf  bidding  a last  adieu  to  the  other  was  the  immediate  cause  of 
his  journey  to  Scotland,  a hope  which,  alas!  wras  indulged  in 
vain.  The  day  on  which  he  reached  the  end  of  his  journey,  her 
remains  were  committed  to  the  dust!  It  may  be  conjectured 
from  these  circumstances,  that  whatever  benefit  may  be  derived 
from  the  apprehension  of  death,  must  in  this  case  have  been 
obtained.  The  expectation  of  this  issue  was  indeed  for  some 
time  so  fixed  that  it  ceased  to  produce  much  agitation;  in  con- 
formity to  that  general  law  of  our  nature,  by  which  almost  all 
men  submit  with  composure  to  a fate  that  is  foreseen,  and  that 
appears  inevitable.  As  however  the  progress  of  disease  and  de- 
bility seemed  to  be  arrested,  the  hope  and  the  loveol  lile  revived, 


Cxass  II.  1. 6. 8.  OF  SENSATION.  255 

and  produced,  from  time  to  time,  the  observations  and  the 
exertions  already  mentioned. 

Wine  and  beer  were  rigorously  abstained  from  during  six 
months  of  the  above  history';  and  all  the  blood,  which  was  taken, 
was  even  to  the  last  buffy.  Feb.  3,  1795. 

It  has  lately  been  asserted,  that  the  people  of  Holland  are  less 
liable  to  consumption  of  the  lungs,  than  those  of  many  other  parts 
of  Europe,  which  has  been  ascribed  to  their  warmer  clothing. 

I am  aware  of  the  difficulty  of  making  such  estimates  with  any 
great  degree  of  certainty,  but  if  such  be  the'  fact,  it  may  indeed 
be  ascribed  with  some  degree  of  probability  to  their  using  very 
warm  clothing,  but  not  very  warm  rooms  during  the  winter  sea- 
son. Whence  the  lungs  are  not  so  much  exposed  to  the  great 
and  sudden  transition  from  very  warm  rooms  into  frosty  air,  as 
in  this  country.  And  though  the  lungs  have  not  a sensation  of 
cold  or  of  chilness  like  the  exernal  skin,  in  passing  from  very 
warm  air  into  great  cold,  often  much  below  the  freezing  point, 
yet  they  are  liable  to  inflammation,  like  other  parts  of  the  sys- 
tem. But  to  this  may  be  objected,  that  the  hereditary  pulmonary 
consumption  attacks  the  patient  so  infallibly  a few  years  after 
puberty,  that  it  does  not  appear  to  depend  much  on  external  cir- 
cumstances. 

8.  Febris  scrofulosa.  The  hectic  fever  occasioned  by  ulcers  of 
the  lymphatic  glands,  when  exposed  to  the  air,  does  not  differ 
from  that  attending  pulmonary  consumption,  being  accompanied 
with  night-sweats  and  occasional  diarrhoea. 

M.  M.  The  bark.  Opium  internally.  Externally  cerussa 
and  bark  in  fine  powder.  Bandage.  Sea-bathing.  See  Class  I. 
2.  3.  21.  and  II.  1.  4.  12. 

9.  Febris  Ischiadica.  A hectic  fever  from  an  open  ulcer  be- 
tween the  muscles  of  the  pelvis,  which  differs  not  from  the  pre- 
ceding. If  the  matter  in  this  situation  lodges  till  part  of  it,  I sup- 
pose, becomes  putrid,  and  aerates  the  other  part;  or  till  it  be- 
comes absorbed  from  some  other  circumstance;  a similar  hectic 
fever  is  produced,  with  night  sweats  or  diarrhoea. 

Mrs. , after  a lying-in,  had  pain  on  one  side  of  her  loins, 

which  extended  to  the  internal  part  of  the  thigh  on  the  same 
side.  No  fluctuation  of  matter  could  be  felt;  she  became  hectic 
with  copious  night-sweats,  and  occasional  diarrhoea,  for  four  or 
five  weeks;  and  recovered  by,  I suppose,  the  total  absorption  of 
the  matter,  and  the  reunion  of  the  walls  of  the  abscess.  See 
Class  II.  1.  2.  18. 

10.  Febris  Arthropuodica.  Fever  from  the  matter  of  diseased 
joints.  Does  the  matter  from  suppurating  bones,  which  generally 


DISEASES 


Class  II.  1.  6.  12. 


256 

has  a very  putrid  smell,  produce  hectic  fever  or  typhous?  See 
Class  II.  1.  4.  16. 

11.  Febris  a pure  contagioso.  Fever  from  contagious  pus. 
When  the  contagious  matters  have  been  produced  on  the  external 
habit,  and  in  process  of  time  become  absorbed,  a fever  is  produced 
in  consequence  of  this  reabsorption;  which  differs  with  the  pre- 
vious irritability  or  inirritability,  as  well  as  with  the  sensibility 
of  the  patient. 

12.  Febris  variolosa  secundaria.  Secondary  fever  of  small-pox. 
In  the  distinct  small-pox  the  fever  is  of  the  sensitive  irritated  or 
inflammatory  kind;  in  the  confluent  small-pox  it  is  of  the  sensi- 
tive inirritated  kind,  or  typhus  gravior.  In  both  of  them  the 
swelling  of  the  face,  when  the  matter  there  begins  to  be  absorbed, 
and  of  the  hands,  when  the  matter  there  begins  to  be  absorbed, 
shew,  that  it  stimulates  the  capillary  vessels  or  glands,  occasion- 
ing an  increased  secretion  greater  than  the  absorbents  can  take 
up,  like  the  action  of  the  cantharides  in  a blister;  now  as  the  ap- 
plication of  a blister  on  the  skin  frequently  occasions  the  stran- 
gury, which  shews,  that  some  part  of  the  cantharides  is  absorbed; 
there  is  reason  to  conclude,  that  a part  of  the  matter  of  small-pox 
is  absorbed,  and  thus  produces  the  secondary  fever.  See  Class  II. 
1.  3.  9.  And  not  simply  by  its  stimulus  on  the  surface  of  the 
ulcers  beneath  the  scabs.  The  exsudalion  of  a yellow  fluid  from 
beneath  the  confluent  eruptions  on  the  face  before  the  height  is 
spoken  of  in  Class  II.  1.3  2. 

The  material  thus  absorbed  in  the  secondary  fever  of  small- 
pox differs  from  that  of  open  ulcers,  as  it  is  only  aerated  through 
the  elevated  cuticle;  and  secondly,  because  there  is  not  a constant 
supply  of  fresh  matter,  when  that  already  in  the  pustules  is  ex- 
hausted, either  by  absorption,  or  by  evaporation,  or  by  its  indura- 
tion into  a scab.  Might  not  the  covering  the  face  assiduously  and 
exactly  with  plasters,  as  with  cerate  of  calamy,  or  with  minium 
plaster,  by  precluding  the  air  from  the  pustules,  prevent  their  con- 
tracting a contagious,  or  acescent,  or  fever  producing  power?  and 
the  secondary  fever  be  thus  prevented  entirely.  If  the  matter  in 
those  pustules  on  the  face  in  the  confluent  small-pox  were  thus 
prevented  from  oxygenation,  it  is  highly  probable,  both  from  this 
theory,  and  from  the  facts  before  mentioned,  that  the  matter 
would  not  erode  the  skin  beneath  them,  and  by  these  means  no 
marks  or  scars  would  succeed. 

13.  Febris  carcinomatosa.  Fever  from  the  matter  of  cancer.  In 
a late  publication  the  pain  is  said  to  be  relieved,  and  the  fever 
cured,  and  the  cancer  eradicated,  by  the  application  of  carbolic 
acid  gas,  or  lixed  air.  See  Class  II.  1.4.  16. 


Class  II.  1.  6.  14. 


OP  SENSATION. 


25 1 


14.  Febris  venerea.  From  the  absorption  of  the  matter  from 
venereal  ulcers  and  suppurating  bones.  See  Syphilis,  II.  1.  5.  2. 

M.  M.  Any  mercurial  calx.  Sarsaparilla?  Mezereon? 

15.  Febris  a same  putrida.  Fever  from  putrid  sanies.  When 
parts  of  the  body  are  destroyed  by  external  violence,  as  a bruise, 
or  by  mortification,  a putrefaction  soon  succeeds;  as  they  are 
kept  in  that  degree  of  warmth  and  moisture,  by  their  adhesion 
to  the  living  parts  of  the  body,  which  most  forwards  that  pro- 
cess. Thus  the  sloughs  of  mortified  parts  of  the  tonsils  give  fe- 
tor to  the  breath  in  some  fevers;  the  matter  from  putrefying 
teeth,  or  other  suppurating  bones,  is  particularly  offensive;  and 
even  the  scurf,  which  adheres  to  the  tongue,  frequently  acquires 
a bitter  taste  from  its  incipient  putridity.  This  material  differs 
from  those  before  mentioned,  as  its  deleterious  property  depends 
on  a chemical  rather  than  an  animal  process. 

16.  Febris  puerpera.  Puerperal  fever.  It  appears  from  some 
late  dissections,  which  have  been  published,  of  those  women  who 
have  died  of  the  puerperal  fever,  that  matter  has  been  formed  in 
the  omentum,  and  found  in  the  cavity  of  the  abdomen,  with 
some  blood  or  sanies.  These  parts  are  supposed  to  have  been 
injured  by  the  exertions  accompanying  labour;  and  as  matter  in 
this  viscus  may  have  been  produced  without  much  pain,  this 
disease  is  not  attended  with  arterial  strength  and  hard  full  pulse, 
like  the  inflammation  of  the  uterus;  and  as  the  fever  is  of  the 
inirritative  or  typhus  kind,  there  is  reason  to  believe,  that  the 
previous  exhaustion  of  the  patient  during  labour  may  contribute 
to  its  production,  as  well  as  the  absorption  of  a material  not 
purulent  but  putrid;  which  is  formed  by  the  delay  of  extrava- 
sated  or  dead  matter  produced  by  the  bruises  of  the  omentum, 
or  other  viscera,  in  the  efforts  of  parturition,  rather  than  by  pu- 
rulent matter,  the  consequence  of  suppuration.  The  pulse  is 
generally  about  120  when  in  bed,  and  in  the  morning;  and  is 
increased  to  134,  or  more,  when  the  patient  sits  up,  or  in  the 
evening  paroxysm.  The  pulse  of  all  very  weak  patients  increases 
in  frequency  when  they  sit  up;  because  the  expenditure  of 
sensorial  power  necessary  to  preserve  an  erect  posture  deducts  so 
much  from  their  general  strength;  and  hence  the  pulse  becomes 
weaker  and  in  consequence  quicker.  See  Sect.  XII.  1.  4. 

Whence  I suspect  that  the  puerperal  fever  is  distinguished 
from  the  hectic  fever,  by  the  former  being  produced  and  sup- 
ported by  the  absorption  of  a putrid  sanies,  arising  from  dead 
parts  of  the  omentum  or  mesentery;  and  the  latter  being  pro- 
duced and  supported  by  the  absorption  of  purulent  matter, 
which  is  the  consequence  of  inflammation,  after  it  has  been  oxy- 
genated by  exposure  to  the  air;  and  that  hence  they  differ  in 

VOI..  II.  L 1 


258 


DISEASES 


Class  If.  1,  6.  1£. 


the  greater  debility,  and  consequent  quicker  pulse,  and  more 
rapid  progress  of  the  former  than  the  latter;  but  agree,  in  the  few 
patients  which  1 have  attended,  in  the  circumstance  of  the 
patients  bearing  the  quantity  of  these  fevers  better  than  the 
typhus,  as  is  seen  in  their  frequent  rising  from  their  beds  for 
hours,  and  even  attending  to  their  occupations  with  a pulse  of 
more  than  120  in  a minute;  and  also  in  another  important  cir- 
cumstance, which  is,  that  they  take  solid  food,  as  bread,  and 
eggs,  and  oysters,  and  even  chicken,  in  great  quantities;  which 
in  the  inirritative  fever,  or  typhus,  is  refused  during  the  whole 
course  of  the  disease.  And  hence  it  seems  probable,  that  the 
cause  or  commencement  of  the  inirritative  fever,  or  typhus,  may 
have  been  from  the  torpor  or  paralysis  of  the  stomach,  owing  to 
the  swallowing  of  contagious  matter  along  with  our  saliva;  and 
the  actions  of  the  heart  suffer  in  consequence  from  sympathy. 
And  that  hence  these  three  kinds  of  fever  may  be  distinguished 
from  each  other;  the  typhus,  by  the  total  loss  of  appetite  for 
solid  food;  the  hectic  fever,  by  the  pulse  being  seldom  above 
120,  and  with  attendant  inflammation;  and  the  puerperal  fever, 
by  a quicker  and  weaker  pulse;  but  both  the  latter  existing 
without  the  inability  to  take  some  solid  nourishment. 

In  this  fever,  time  must  be  allowed  for  the  absorption  of  the 
matter.  Very  large  and  repeated  quantities  of  the  bark,  by  pre- 
venting sufficient  food  from  being  taken,  as  bread,  and  wine, 
and  water,  I have  thought,  have  much  injured  the  patient;  for 
the  bark  is  not  here  given,  as  in  intermittent  fevers,  to  prevent 
the  paroxysm,  but  simply  to  strengthen  the  patient  by  increasing 
the  power  of  digestion.  About  two  ounces  of  decoction  of  bark, 
with  four  drops  of  laudanum,  and  a drachm  of  sweet  spirits  of 
vitriol,  once  in  six  hours,  and  a glass  of  wine  between  those  times, 
with  panada,  or  other  food,  I have  thought  of  most  advantage, 
with  a small  blister  occasionally. 

Where  not  only  the  stomach  but  also  the  bowels  are  much 
distended  with  air,  so  as  to  sound  on  striking  them  with  the  fin- 
gers, the  case  is  always  dangerous,  generally  hopeless;  which 
is  more  so  in  proportion  to  the  quickness  of  the  pulse.  Where 
the  bowels  are  distended  two  drops  of  oil  of  cinnamon  should 
be  given  in  the  panada  three  or  four  times  a day,  with  ten  grains 
of  alum. 

In  one  case  of  puerperal  fever,  which  lasted  above  forty  days, 
and  was  amended  for  the  last  fortnight  with  perpetual  subsultus 
of  the  tendons,  and  even  twitching  of  the  hands  with  unceasing 
delirium,  and  inability  to  sleep,  musk  given  in  the  dose  of  ten 
grains  every  six  hours,  with  five  drops  of  tincture  of  opium, 
seemed  to  be  of  service;  and  when  the  abdomen  became  tumid 


Class  II.  1.  6.  16. 


OF  SENSATION. 


259 


with  air,  about  the  36th  day  from  the  commencement  of  the 
fever,  alum  given  in  doses  of  about  seven  grains  every  three 
hours,  seemed  of  uncommon  service,  as  the  tumour  of  the  abdo- 
men much  subsided  in  one  day,  and  the  patient  immediately  be- 
came able  to  sleep  two  or  three  hours  at  a time;  but  the  event 
of  the  disease  was  fatal. 

In  this  situation  I suppose  the  fever  to  have  been  kept  up  by 
the  absorption  of  a putrid  material  in  the  abdomen,  on  the 
outside  of  the  intestines;  and  as  alum  instantaneously  destroys 
the  volatile  alkali  which  occasions  a part  of  the  smell,  and  per- 
haps the  whole  of  the  gas  of  putrid  matter;  which  alkali  pre- 
cipitates the  argillaceous  earth  from  the  vitriolic  acid;  I sup- 
pose this  effect  would  be  produced  by  alum,  though  it  might 
not  be  produced  by  vitriolic  acid,  as  the  latter  would  unite  with 
the  contents  of  the  stomach;  but  the  alum  would  not  unite 
with  any  thing,  till  it  became  exposed  to  exhalations  of  putrid 
matter.  See  Class  II.  1.  3.  1.  Might  not  a puncture  by  a lan- 
cet into  the  tumid  abdomen,  through  the  scar  of  the  navel,  be  of 
use,  when  it  is  much  distended  with  air? 

The  want  of  sleep  was  owing  to  debility,  and  ceased  when 
that  became  lessened.  As  some  motions  of  the  hands  were  the 
consequence  of  her  delirious  ideas,  these  became  tremulous,  like 
the  bands  of  very  old  men,  or  drunkards,  from  debility  whenever 
they  were  exerted. 

A very  interesting  account  of  the  puerperal  fever,  which  was 
epidemic  at  Aberdeen,  has  been  lately  published  by  Dr.  Alexan- 
der Gordon.  (Robinsons,  London.)  In  several  dissections  of 
those  who  died  of  this  disease,  purulent  matter  was  found  in  the 
cavity  of  the  abdomen;  which  he  ascribes  to  an  erysipelatous 
inflammation  of  the  peritonasum,  as  its  principal  seat,  and  of  its 
productions,  as  the  omentum,  mesentery,  and  peritonaeal  coat  of 
the  intestines. 

He  believes,  that  it  was  infectious,  and  that  the  contagion  was 
always  carried  by  the  accoucheur,  or  the  nurse,  from  one  lying-in 
woman  to  another. 

The  disease  began  with  violent  unremitting  pain  of  the  abdo- 
men on  the  day  of  delivery,  or  the  next  day,  with  shuddering, 
and  very  quick  pulse,  often  140  in  a minute.  In  this  situation 
if  he  saw  the  patient  within  12  or  24  hours  of  her  seizure,  he 
took  away  from  16  to  24  ounces  of  blood,  which  was  always 
sizy.  He  then  immediately  gave  a cathartic,  consisting  of  three 
grains  of  calomel,  and  forty  grains  of  powder  of  jalap.  After 
this  had  operated,  he  gave  an  opiate  at  night;  and  continued  the 
purging  and  the  opiate  for  several  days. 

He  asserts,  that  almost  all  those,  whom  he  was  permitted  to 


260 


DISEASES 


Class  II.  1.  6.  1G. 


treat  in  this  manner  early  in  the  disease,  recovered,  to  the  num- 
ber of  50;  and  that  almost  all  the  rest  died.  But  that  when 
two  or  three  days  were  elapsed,  the  patient  became  too  weak 
for  this  method;  and  the  matter  was  already  formed,  which  de- 
stroyed them.  Except  that  he  saw  two  patients  who  recovered, 
after  discharging  a large  quantity  of  matter  at  the  navel.  And 
a few  who  were  relieved,  by  the  appearance  of  external  erysipe- 
las on  the  extremities. 

This  disease,  consisting  of  an  erysipelatous  inflammation,  may 
occasion  the  great  debility  sooner  to  occur  than  in  inflammation 
of  the  uterus;  which  latter  is  neither  erysipelatous,  I suppose, 
nor  contagious.  And  the  success  of  Dr.  Gordon’s  practice 
seems  to  correspond  with  that  of  Dr.  Rush,  in  the  contagious 
fever  or  plague  at  Philadelphia;  which  appeared  to  be  much  as- 
sisted by  early  evacuations.  One  case  I saw,  some  time  ago, 
where  violent  unceasing  pain  of  the  whole  abdomen  occurred,  a 
few  hours  after  delivery,  with  quick  pulse;  which  ceased  after 
the  patient  had  twice  lost  about  eight  ounces  of  blood,  and  had 
taken  a moderate  cathartic  with  calomel. 

This  case  induces  me  to  think,  that  it  might  be  safer,  and 
equally  efficacious,  to  take  less  blood  at  first  than  Dr.  Gordon 
mentions,  and  to  repeat  the  operation  in  a few  hours,  if  the 
continuance  of  the  symptoms  should  require  it.  And  the  same 
in  respect  to  the  cathartic,  which  might  perhaps  be  given  in  less 
quantity,  and  repeated  every  two  or  three  hours. 

Nor  should  I wish  to  give  an  opiate  after  the  first  venesection 
and  cathartic;  as  I suspect  that  this  might  be  injurious,  except 
those  evacuations  had  emptied  the  vessels  so  much,  that  the  sti- 
mulus of  the  opiate  should  act  only  by  increasing  the  absorption 
of  the  new  vessels  or  fluids  produced  on  the  surfaces  of  the  inflam- 
ed membranes.  In  other  inflammations  of  the  bowels,  and 
in  acute  rheumatism,  I have  seen  the  disease  much  prolonged, 
and  I believe  sometimes  rendered  fatal,  by  the  too  early  adminis- 
tration of  opiates,  either  along  with  cathartics,  or  at  their  inter- 
vals; while  a small  dose  of  opium  given  after  sufficient  evacua- 
tions produces  absorption  only  by  its  stimulus,  and  much  con- 
tributes to  the  cure  of  the  patient.  We  may  have  visible  testi- 
mony of  this  effect  of  opium,  when  a solution  of  it  is  put  into 
an  inflamed  eye;  if  it  be  thus  used  previous  to  sufficient  evacua- 
tion, it  increases  the  inflammation;  if  it  be  used  after  sufficient 
evacuation,  it  increases  absorption  only,  and  clears  the  eye  in  a 
very  small  time. 

I cannot  omit  observing,  from  considering  these  circumstances, 
how  unwise  is  the  common  practice  of  giving  an  opiate  to  every 


OF  SENSATION. 


Class  II.  1.  6. 17. 


261 


woman  immediately  after  her  delivery,  which  must  often  have 
been  of  dangerous  consequence. 

17.  Febris  a spliacelo.  Fever  from  mortification.  This  fever 
from  absorption  of  putrid  matter  is  of  the  inirritative  or  typhus 
kind.  See  the  preceding  article. 

M.  M.  Opium  and  the  bark  are  frequently  given  in  too 
great  quantity,  so  as  to  induce  consequent  debility,  and  *o  oppress 
the  power  of  digestion. 


262 


DISEASES 


Class  1/.  1.  7.  1 


ORDO  I. 

Increased  Sensation. 

GENUS  VII. 

With  increased  dictions  of  Organs  of  Sense. 
SPECIES. 

1.  Delirium  febrile.  Paraphrosyne.  The  ideas  in  delirium 
consist  of  those  excited  by  the  sensation  of  pleasure  or  pain, 
■which  precede  them,  and  the  trains  of  other  ideas  associated 
with  these,  and  not  of  these  excited  by  external  irritations  or  by 
voluntary  exertion.  Hence  the  patients  do  not  know  the  room 
which  they  inhabit,  or  the  people  who  surround  them;  nor  have 
they  any  voluntary  exertion,  where  the  delirium  is  complete;  so 
that  their  efforts  in  walking  about  a room  or  rising  from  their 
bed  are  unsteady,  and  produced  by  their  catenations  with  the  im- 
mediate affections  of  pleasure  or  pain.  See  Section  XXXIII.  1 . 4. 

By  the  above  circumstances  it  is  distinguished  from  madness, 
in  which  the  patients  well  know  the  persons  of  their  acquaintance, 
and  the  place  where  they  are;  and  perform  all  the  volun- 
tary actions  with  steadiness  and  determination.  See  Sect. 
XXXIV.  2.  2. 

Delirium  is  sometimes  less  complete,  and  then  a new  face  and 
louder  voice  stimulate  the  patient  to  attend  to  them  for  a few  mo- 
ments; and  then  they  relapse  again  into  perfect  delirium.  At 
other  times  a delirium  affects  but  one  sense,  and  the  person  thinks 
he  sees  things  which  do  not  exist;  and  is  at  the  same  time  sen- 
sible to  the  questions  which  are  asked  him,  and  to  the  taste  of 
the  food  which  is  offered  to  him. 

This  partial  delirium  is  termed  a hallucination  of  the  disor- 
dered organ;  and  may  probably  arise  from  the  origin  of  one  nerve 
of  sense  being  more  liable  to  inflammation  than  the  others;  that 
is,  an  exuberance  of  the  sensorial  power  of  sensation  may  affect 
it;  which  is  therefore  thrown  into  action  by  slighter  sensitive 
catenations,  without  being  obedient  to  external  stimulus,  or  to 
the  power  of  volition. 

The  perpetual  flow  of  ideas  in  delirium  is  owing  to  the  same 
circumstance,  as  of  those  in  our  dreams;  namely,  to  the  defect 
or  paralysis  of  the  voluntary  power;  as  in  hemiplegia,  when  one 
side  of  the  body  is  paralytic,  and  thus  expends  less  of  the  sensorial 
power,  the  limos  on  the  other  side  are  in  constant  motion  from 


Class  H.  1.7.  2. 


OF  SENSATION. 


268 


the  exuberance  of  it.  Whence  less  sensorial  power  is  exhausted 
in  delirium,  than  at  other  times,  as  well  as  in  sleep;  and  hence  in 
fevers  with  great  debility,  it  is  perhaps,  as  well  as  the  stupor, 
rather  a favourable  circumstance;  and  when  removed  by  nume- 
rous blisters,  the  death  of  the  patient  often  follows  the  recovery  of 
his  understanding.  See  Class  I.  2.  5.  6.  and  I.  2.  5.  10. 

Delirium  in  diseases  from  inirritability  is  sometimes  preceded 
by  a propensity  to  surprise.  See  Class  T.  1.  5.  12. 

M.  M.  Fomentations  of  the  shaved  head  for  an  hour  repeat- 
edly. A blister  on  the  head.  Rising  from  bed.  Wine  and 
opium,  and  sometimes  venesection  in  small  quantity  by  cupping, 
if  the  strength  of  the  arterial  system  will  allow  it. 

2.  Delirium  manicicale.  Maniacal  delirium.  There  is  ano- 
ther kind  of  delirium,  described  in  Sect.  XXXIII.  1.  4.  which  has 
the  increase  of  pleasurable  or  painful  sensation  for  its  cause, 
without  any  diminution  of  the  other  sensorial  powers;  but  as 
this  excites  the  patient  to  the  exertion  of  voluntary  actions,  for 
the  purpose  of  obtaining  the  object  of  his  pleasurable  ideas,  or 
avoiding  the  object  of  his  painful  ones,  such  as  perpetual  prayer, 
when  it  is  of  the  religious  kind;  it  belongs  to  the  insanities  de- 
scribed in  Class  III.  1.2.  1.  and  is  more  properly  termed  hal- 
lucinatio  maniacalis. 

3.  Delirium  ebrietatis.  The  drunken  dilirium  is  in  nothing 
different  from  the  delirium  attending  fevers  except  in  its  cause, 
as  from  alcohol,  or  other  poisons.  Wlien  it  is  attended  with  an 
apoplectic  stupor,  the  pulse  is  generally  low;  and  venesection 
I believe  sometimes  destroys  those,  who  would  otherwise  have 
recovered  in  a few  hours. 

M.  M.  Diluting  liquids.  An  emetic. 

4.  Somnium.  Dreams  constitute  the  most  complete  kind  of 
delirium.  As  in  these  no  external  irritations  are  attended  to, 
and  the  power  of  volition  is  entirely  suspended;  so  that  the 
sensations  of  pleasure  and  pain,  with  their  associations,  alone  ex- 
cite the  endless  trains  of  our  sleeping  ideas;  as  explained  in 
Sect.  XVIII.  on  sleep. 

5.  Hallucinatiovistis.  Deception  of  sight.  These  visual  hal- 
lucinations are  perpetual  in  our  dreams;  and  sometimes  pre- 
cede general  delirium  in  fevers;  and  sometimes  belong  to  reverie, 
and  to  insanity.  See  Class  III.  1.2.  1.  and  2.  and  must  be 
treated  accordingly. 

Other  kinds  of  visual  hallucinations  occur  by  moon-light; 
when  objects  are  not  seen  so  distinctly  as  to  produce  the  usual 
ideas  associated  with  them,  but  appear  to  us  exactly  as  they  are 
seen.  Thus  the  trunk  of  a tree  appears  a flat  surface,  instead  of 


DISEASES 


Cuss  11.  1.  7.  6. 


264 

a cylinder  as  by  day,  and  we  are  deceived  and  alarmed  by  see- 
ing things  as  they  really  are  seen.  See  Berkley  on  Vision. 

6.  Hallucinatio  auditds.  Auricular  deception  frequently  oc- 
curs in  dreams,  and  sometimes  precedes  general  delirium  in  fe- 
vers; and  sometimes  belongs  to  vertigo,  and  to  reverie,  and  to 
insanity.  See  Sect.  XX.  7.  and  Class  III.  1.2.  1.  and  2. 

7.  Rubor  a calore.  The  blush  from  heat  is  occasioned  by  the 
increased  action  of  the  cutaneous  vessels  in  consequence  of  the 
increased  sensation  of  heat.  See  Class  I.  1.  2.  1.  and  3. 

S Rubor  jucunditatis.  The  blush  of  joy  is  owing  to  the  in- 
creased action  of  the  capillary  arteries,  along  with  that  of  every 
moving  vessel  in  the  body,  from  the  increase  of  pleasurable  sen- 
sation. 

9.  Priapismus  amaiorius.  Amatorial  priapism.  The  blood 
is  poured  into  the  cells  of  the  corpora  cavernosa  much  faster 
than  it  can  be  reabsorbed  by  the  vena  penis,  owing  in  this  case 
to  the  pleasurable  sensation  of  love  increasing  the  arterial  action 
See  Class  I.  1.  4.  6. 

10.  Distentio  mamularum.  The  teats  of  female  animals,  when 
they  give  suck,  become  rigid  and  erected,  in  the  same  manner  as 
in  the  last  article,  from  the  pleasurable  sensation  of  the  love  of  the 
mother  to  her  offspring.  Whence  the  teat  may  properly  be  called 
an  organ  of  sense.  The  nipples  of  men  do  the  same  when  rub- 
bed with  the  hand.  See  Class  I.  1.4.  7. 


0IASS  II.  1.  1. 


OF  SENSATION. 


2*65 


ORDO  II. 

Decreased  Sensation. , 

GENUS  I. 

Of  the  General  System, 

SPECIES. 

1 . Stultitia  insensibilis.  Folly  from  insensibility.  The  plea- 
sure or  pain  generated  in  the  system  is  not  sufficient  to  promote 
the  usual  activity  either  of  the  sensorial  or  muscular  fibres. 

2.  Tcedium  vitae.  Ennui.  Irksomeness  of  life.  The  pain  of 
laziness  has  been  thought  by  some  philosophers  to  be  that  prin- 
ciple of  action,  which  has  excited  all  our  industry,  and  distin- 
guished mankind  from  the  brutes  of  the  field.  It  is  certain  that, 
where  the  ennui  exists,  it  is  relieved  by  the  exertions  of  our  minds 
or  bodies,  as  all  other  painful  sensations  are  relieved;  but  it  de- 
pends much  upon  our  early  habits,  whether  we  become  patient 
of  laziness,  or  inclined  to  activity,  during  the  remainder  of  our 
lives,  as  other  animals  do  not  appear  to  be  affected  with  this 
malady;  which  is  perhaps  less  owing  to  deficiency  of  the  plea- 
surable sensation,  than  to  the  superabundancy  of  voluntary  power 
which  occasions  pain  in  the  muscles  by  its  accumulation;  as  ap- 
pears from  the  perpetual  motions  of  a squirrel  confined  in  a cage. 

3.  Paresis  se.nsitiva . Weakness  of  the  whole  system  from  in- 
sensibility. 


voi.  II. 


m m 


266 


DISEASES 


Class  II  2.  2.  1. 


ORDO  II. 

Decreased  Sensation . 

GENUS  II. 

Of  particular  Organs. 


SPECIES. 

1.  Anorexia.  Want  of  appetite.  Some  elderly  people,  and 
those  debilitated  by  fermented  liquors,  are  liable  to  lose  their  ap- 
petite for  animal  food;  which  is  probably  in  part  owing  to  the 
deficiency  of  gastric  acid,  as  well  as  to  the  general  decay  of  the 
system:  elderly  people  will  go  on  years  without  animal  food;  but 
inebriates  soon  sink,  when  their  digestion  becomes  so  far  impaired. 
Want  of  appetiie  is  sometimes  produced  by  the  putrid  matter 
from  many  decaying  teeth  being  perpetually  mixed  with  the  saliva, 
and  thence  affecting  the  organs  of  taste,  and  greatly  injuring  the 
digestion. 

M.  M.  Fine  charcoal  powder  diffused  in  warm  water,  held  in 
the  mouth  frequently  in  a day,  as  in  Class  I.  1.4.  4.  or  solution 
of  alum  in  water.  Extract  the  decayed  teeth.  An  emetic.  A 
blister.  Chalybeates.  Vitriolic  acid.  Bile  of  an  ox  inspissated, 
and  made  into  pills;  20  grains  to  be  taken  before  dinner  and 
supper.  Opium  half  a grain  twice  a day. 

All  the  strength  we  possess  is  ultimately  derived  from  the 
food,  which  we  are  able  to  digest;  wdience  a total  debility  of  the 
system  frequently  follows  the  want  of  appetite,  and  of  the  power 
of  digestion.  Some  young  ladies  I have  observed  to  fall  into 
this  general  debility,  so  as  but  just  to  be  able  to  walk  about;  which 
I have  sometimes  ascribed  to  their  voluntary  fasting,  when  they 
believed  themselves  too  plump;  and  who  have  thus  lost  both 
their  health  and  beauty  by  too  great  abstinence,  which  could  never 
be  restored. 

Two  young  ladies  applied  to  me,  who  had  experienced  many 
months  of  greal  debility,  and  of  almost  total  want  of  appetite, 
from  another  cause,  which  was  from  bathing  on  a warm  day  in  a 
cold  fountain  of  water,  which  was  covered  from  the  sun  and  sup- 
plied by  a powerful  spring;  but  gradually  afterwards  recovered 
their  healthy  by  the  use  of  six  grains  of  rhubarb  with  one  grain  of 
opium  every  night  for  some  weeks,  and  a bitter  draught  twice  a 
day  with  a slight  chalybeate.  See  Class  III.  2.  1 . 17. 

I have  seen  other  cases  of  what  may  be  termed  anorexia  epi- 


Class  II.  2.  2.  2. 


OF  SENSATION. 


267 


leptica,  in  which  a total  loss  of  appetite,  and  of  the  power  of  di- 
gestion, suddenly  occurred  along  with  epileptic  fits.  Miss  B.  a 
girl  about  eighteen,  apparently  very  healthy,  and  rather*  plump, 
was  seized  with  fits,  which  were  at  first  called  hysterical;  they 
occurred  at  the  end  of  menstruation,  and  returned  very  fre- 
quently with  total  loss  of  appetite.  She  was  relieved  by  vene- 
section, blisters  and  opiates;  her  strength  diminished,  and  after 
some  returns  of  the  fits,  she  took  to  her  bed,  and  has  survived 
15  or  20  years;  she  has  in  general  eaten  half  a potato  a day, 
and  seldom  speaks  but  retains  her  senses,  and  had  many  years 
occasional  returns  of  convulsion.  I have  seen  two  similar  cases 
where  the  anorexia,  or  want  of  appetite,  was  in  less  degree; 
and  but  just  so  much  food  could  be  digested,  as  supplied  them 
with  sufficient  strength  to  keep  from  the  bed  or  sofa  for  half  a day. 
As  well  as  I can  recollect,  all  these  patients  were  attended  with 
weak  pulse  and  cold  pale  skin;  and  received  benefit  by  opium, 
from  a quarter  of  a grain  to  a grain  four  times  a day.  See  Class 
III.  1.  1.7.  and  III.  1.  2.  20.  and  Suppl.  I.  14.  3. 

2 Adipsia.  Want  of  thirst.  Several  of  the  inferior  people, 
as  farmers’  wives,  have  a habit  of  not  drinking  with  their  dinner 
at  all,  or  only  take  a spoonful  or  two  of  aie  after  it.  I have 
frequently  observed  these  to  labour  under  bad  digestion,  and  de- 
bility in  consequence;  which  I have  ascribed  to  the  too  great 
stimulus  of  solid  food  undiluted,  destroying  in  process  of  time 
the  irritability  of  the  stomac  h. 

3.  Impotentia  (agenesia.)  Impolency  much  seldomer  happens 
to  the  male  sex  than  sterility  to  the  female  sex.  Sometimes  a 
temporary  impotence  occurs  from  bashfulness,  or  the  interference 
of  some  voluntary  exertion  in  the  production  of  an  effect,  which 
should  be  performed  alone  by  pleasurable  sensation. 

One  who  was  soon  to  be  married  to  a lady  of  superior  condi- 
tion to  his  own,  expressed  fear  of  not  succeeding  on  the  wedding 
nif>b  . he  was  advised  to  take  a grain  of  opium  before  he  went 
to  bed,  and  to  accustom  himself  to  sleep  with  a woman  previously, 
but  not  to  enjoy  her,  to  take  off  his  bashfuiness;  which  succeeded 
to  his  wish. 

Mr.  John  Hunter  in  his  work  on  the  venereal  disease,  has  given 
an  ingenious  section  on  this  subject  of  mental  impotence,  in  which 
he  relates  a successful  mode  of  treatment.  He  prevailed  on  a person 
in  this  situation  to  promise  on  his  honour  to  pass  six  nights  in  bed 
with  a young  woman  without  attempting  to  have  connection  with 
her,  whatever  might  be  his  power  or  inclination.  He  after- 
wards assured  Mr.  Hunter,  that  this  resolution  had  produced 
such  a total  alteration  in  the  state  of  his  mind,  that  the  power  of 
connection  soon  recurred,  for  instead  of  going  to  bed  with  the 


268 


DISEASES 


Class  II.  2.  2.  4. 


fear  of  inability,  he  went,  with  fears,  that  he  should  be  possess- 
ed with  too  much  desire,  and  too  much  power,  so  as  to  become 
uneasy  to  him,  which  really  happened,  as  he  would  have  been 
happy  to  have  shortened  the  time;  and  when  he  had  once  broken 
the  spell,  his  mind  and  powers  went  on  together;  and  his  mind 
never  returned  to  its  former  state. 

A gentleman  about  50  years  of  age,  who  had  lived  too  freely, 
as  he  informed  me,  both  in  respect  to  wine  and  women,  com- 
plained that  his  desire  for  the  sex  remained,  and  that  he  occa- 
sionally parted  with  semen,  but  with  defect  of  a perfect  tensio 
penis,  and  that  he  had  tried  20  drops  of  laudanum,  and  20  drops 
of  tincture  of  cantharides  on  going  to  bed  without  effect;  and 
that  as  the  debility  or  inirritability  of  the  system  in  this  case 
rather  than  any  mental  affection  seemed  to  be  a part  of  the  cause, 
he  was  advised  to  stimulate  the  sphincter  ani  by  the  introduction 
of  a piece  of  the  root  of  ginger,  as  is  done  by  the  horse-dealers  to 
sale-horses.  And  however  ridiculous  the  operation  may  appear, 
he  assured  me  that  it  succeeded;  which  I suppose  might  be  owing 
to  the  sympathy  between  the  sphincter  ani  and  the  penis;  which 
is  so  often  the  cause  of  painful  sensation  in  the  former,  when  a 
stone  at  the  neck  of  the  bladder  affects  the  latter;  and  conversely 
when  painful  piles  affect  the  rectum,  a strangury  is  sometimes 
produced  by  sympathy. 

For  restoring  the  venereal  power  M.  Le  Roy  thinks  phospho- 
rus taken  in  the  dose  of  a quarter  of  a grain  rubbed  with  oil  or 
yolk  of  egg,  or  honey;  or  even  the  acid  of  phosphorous,  to  pos- 
sess great  efficacy.  Med.  Review,  Vol.  V.  p.  204.  The  water  in 
which  phosphorus  has  been  kept  some  time,  probably  possesses 
some  of  this  acid,  and  is  also  recommended  by  M.  Le  Roy. 
I ought  here  to  add,  that  I have  been  lately  informed,  that  a gen- 
tleman directed  four  grains  of  phosphorus  to  be  made  into  pills 
with  conserve,  with  design  of  increasing  his  venereal  power. 
He  was  seized  with  intolerable  sense  of  heat  at  his  stomach, 
pulse  feeble,  but  not  quickened,  livid  countenance,  soreness  of 
his  bowels  to  the  touch,  and  incessant  vomitings,  by  which  he 
at  last  brought  up  some  blood.  His  illness  lasted  five  or  six  days. 
He  did  not  acknowledge  any  cause  of  his  sudden  illness,  but 
said  he  was  certain  emetics  would  cure  him,  and  took  two  by  his 
own  request.  After  his  death,  the  apothecary  mentioned  his  hav- 
ing directed  the  pills  as  above,  which  were  made  three  days  be- 
fore he  was  taken  ill;  and  he  was  believed  to  have  taken  about 
half  of  them. 

M.  M.  Chalybeates.  Opium.  Bark.  Tincture  of  can- 
tharides. 

4.  Sterilitas.  Barrenness.  One  of  the  ancient  medical  wri- 


Class  II.  2.  2.  5. 


OF  SENSATION. 


26  9 


ters  asserts,  that  the  female  sex  become  pregnant  with  most  cer- 
tainty at  or  near  the  time  of  menstruation.  This  is  not  im- 
probable, since  these  monthly  periods  seem  to  resemble  the 
monthly  venereal  orgasm  of  some  female  quadrupeds,  which  be- 
come pregnant  at  those  times  only;  and  hence  the  computation 
of  pregnancy  is  not  often  erroneous,  though  taken  from  the  last 
menstruation.  See  Sect.  XXXVI.  2.  3. 

M.  M.  Opium  a grain  every  night.  Chalybeates  in  very 
small  doses.  Bark.  Sea-bathing. 

5.  Insensibilitas  artuum.  As  in  some  paralytic  limbs.  A great 
insensibility  sometimes  accompanies  the  torpor  of  the  skin  in  cold 
fits  of  agues.  Some  parts  have  retained  the  sense  of  heat,  but 
not  the  sense  of  touch.  See  Sect.  XVI.  6. 

M.  M.  Friction  with  flannel.  A blister.  Warmth. 

6.  Disuria  insensitiva.  Insensibility  of  the  bladder.  A diffi- 
culty or  total  inability  to  make  water  attends  some  fevers  with 
great  debility,  owing  to  the  insensibility  or  inirritability  of  the 
bladder.  This  is  a dangerous  but  not  always  a fatal  symptom. 
See  Class  III.  2.  1.  6. 

M.  M.  Draw  off  the  water  with  a catheter.  Assist  the  pa- 
tient in  the  exclusion  of  it  by  compressing  the  lower  parts  of  the 
abdomen  with  the  hands.  Wine  two  ounces,  Peruvian  bark 
one  dram  in  decoction,  every  three  hours  alternately.  Balsam 
of  copaiva.  Oil  of  almonds,  with  as  much  camphor  as  can  be 
dissolved  in  it,  applied  as  a liniment  rubbed  on  the  region  of  the 
bladder  and  perinasum,  and  repeated  every  four  hours,  was  used 
in  this  disease  with  success  by  Mr.  Latham.  Med.  Comment. 
1791,  p.  213. 

7.  Accumulatio  alvina.  An  accumulation  of  feces  in  the 
rectum,  occasioned  by  the  torpor,  or  insensibility  of  that  bowel. 
But  as  liquids  pass  by  these  accumulations,  it  differs  from  the 
constipatio  alvi,  which  is  owing  to  too  great  absorption*  of  the 
alimentary  canal. 

Old  milk,  and  especially  when  boiled,  is  liable  to  induce  this 
kind  of  costiveness  in  some  grown  persons;  which  is  probably 
owing  to  their  not  possessing  sufficient  gastric  acid  to  curdle  and 
digest  it;  for  as  both  these  processes  require  gastric  acid,  it  fol- 
lows that  a greater  quantity  of  it  is  necessary,  than  in  the  diges- 
tion of  other  aliments,  which  do  not  previously  require  being 
curdled.  This  ill  digested  milk  not  sufficiently  stimulating  the 
rectum,  remains  till  it  becomes  a too  solid  mass.  On  this  ac- 
count milk  seldom  agrees  with  those,  who  are  subject  to  piles, 
by  inducing  costiveness  and  large  stools. 

M.  M.  Extract  the  hardened  scybala  by  means  of  a marrow- 
spoon;  or  by  a piece  of  wire,  or  of  whale-bone  bent  into  a bow 


270 


DISEASES 


C/LA9S  II.  2.  2.  7. 


and  introduced.  Injections  of  oil.  Castor  oil,  or  oil  of  al- 
monds, taken  by  the  mouth.  A large  clyster  of  smoke  of  to- 
bacco. Six  grains  of  rhubarb  taken  every  night  for  many 
months.  Aloes.  An  endeavour  to  establish  a habit  of  evacua- 
tion at  a certain  hour  daily.  See  Class  I.  1.  3.  5. 


Ciass  II.  3.  1.1. 


OF  SENSATION. 


271 


ORDO  III. 

Retrograde  Sensitive  Motions. 

GENUS  I. 

Of  Excretory  Ducts. 

The  retrograde  action  of  the  oesophagus  in  ruminating  ani- 
mals, when  they  bring  up  their  food  from  their  first  stomach  for 
the  purpose  of  a second  mastication  of  it,  may  probably  be  caused 
by  agreeable  sensation;  similar  to  that  which  induces  them  to 
swallow  it  both  before  and  after  this  second  mastication;  and 
then  this  retrograde  action  properly  belongs  to  this  place,  and  is 
erroneously  put  at  the  head  of  the  order  of  irritative  retrograde 
motions.  Class  I.  3.  1.  1. 

SPECIES. 

1 . Ureterum  moius  retrogressus.  When  a stone  has  advanced 
into  the  ureter  from  the  pelvis  of  the  kidney,  it  is  sometimes  lia- 
ble to  be  returned  by  the  retrograde  motion  of  that  canal,  and 
the  patient  obtains  fallacious  ease,  till  the  stone  is  again  pushed 
into  the  ureter. 

2.  Urethrae  motus  retrogressus.  There  have  been  instances  of 
bougies  being  carried  up  the  urethra  into  the  bladder  most  pro- 
bably by  an  inverted  motion  of  this  canal;  for  which  some  have 
undergone  an  operation  similar  to  that  for  the  extraction  of  a 
stone.  A case  is  related,  in  some  medical  publication,  in  which 
a catgut  bougie  was  carried  into  the  bladder,  and,  after  remain- 
ing many  weeks,  was  voided  piece-meal  in  a semi-dissolved  state. 
Another  case  is  related  of  a French  officer,  who  used  a leaden 
bougie;  which  at  length  found  its  way  into  the  bladder,  and  was, 
by  injecting  crude  mercury,  amalgamated  and  voided. 

In  the  same  manner  the  infection,  from  a simple  gonorrhoea, 
is  probably  carried  further  along  the  course  of  the  urethra;  and 
small  stones  frequently  descend  some  way  into  the  urethra,  and  are 
again  carried  up  into  the  bladder  by  the  inverted  action  of  this  ca- 
nal. 

3.  Ductus  clioledochi  motus  retrogressus.  The  concretions  of 
bile,  called  gall-stones,  frequently  enter  the  bile  duct,  and  give 
violent  pain  for  some  hours;  and  return  again  into  the  gall-blad- 
der, by  the  retrograde  action  of  this  duct.  May  not  oil  ! e car- 
ried up  this  duct,  when  a gall-stone  gives  great  pain,  by  its  re- 
trograde spasmodic  action?  See  Class  I.  1.3.  8, 

M.  M.  Opium  a grain  and  a half. 


2'72 


DISEASES 


Class  HI.  1. 1‘. 


The  Orders  and  Genera  of  the  Third  Class  of 
Diseases. 

CLASS  III. 

DISEASES  OF  VOLITION. 

ORDO  I. 

Increased  Volition. 

GENERA. 

1.  Witlnncreased  actions  of  the  muscles. 

2.  With  increased  actions  of  the  organs  of  sense. 

ORDO  II. 

Decreased  Volition. 

GENERA. 

1.  With  decreased  actions  of  the  muscles. 

2.  With  decreased  actions  of  the  organs  of  sense. 

The  Orders,  Genera,  and  Species,  of  the  Third  Class 
of  Diseases. 

CLASS  III, 

DISEASES  OF  VOLITION. 

ORDO  I. 

Increased  Volition. 

GENUS  I. 

With  increased  Actions  of  the  Muscles. 

SPECIES. 


1.  Jactitatio. 

2.  Tremor febrilis 


Restlessness 
[^Febrile  trembling. 


C1AS9  III.  1.  2. 


OP  SENSATION. 


373 


3.  Clamor 

4.  Risus 

5.  Convulsio 
debilis 

6.  dolorijica 

7.  Epilepsia 

8.  dolorijica 

9.  Somnambulismus 

10.  Asthma  convulsivum 

11.  dolorijicum 

12.  Stridor  dentimn 

13.  Tetanus  trismus 

14.  dolorijicus 

15.  Hydrophobia 


Screaming 

Laughter 

Convulsion 

— weak 

painful 

Epilepsy 

painful 

Sleep-walking 
Asthma  convulsive 

' painful 

Gnashing  of  the  teeth 
Cramp  of  the  jaw 

painful 

Dread  of  water 


GENUS  II. 

With  increased  Actions  of  the  Organs  of  Sense-, 
SPECIES. 


1 . Mania  mutabilis 

2.  Stadium  inane 

3.  Vigilia 

4.  Erotomania 

5.  Amor  sui 

6.  JYostalgia 

7.  Spes  religiosa 

S.  Superbia  stenmatis 
9.  Ambit  io 

10.  Mceror 

1 1 . Tcedium  vitae 

1 2 . Desiderium  pulchri  tudinis 

13.  Pauperlatis  timor 

14.  Letlii  timor 

15.  Or ci  timor  , 

16.  Satyriasis 

17.  Ira 

18.  Rabies 

19.  Citta 

20.  Cacositia 

21.  Syphilis  imaginaria 

22.  Psora  imaginaria 

23.  Tabes  imaginaria 

24.  Sijmpathia  aliena 

25.  Educatio  heroica 

VOT..  If. 


Mutable  madness 
Reverie 
Watchfulness 
Sentimental  love 
Vanity 

Desire  of  home 
Superstitious  hope 
Pride  of  family 
Ambition 
Grief 

Irksomeness  of  life 
Loss  of  beauty 
Fear  of  poverty 

of  death 

of  hell 

Lust 

Anger 

Rage 

Depraved  appetite 
Aversion  to  food 
Imaginary  pox 

itch 

— tabes 

Pity 

Heroic  education 
N n 


274 


DISEASES 


Class  III.  2. 1. 


ORDO  If. 

Decreased  Volition. 

GENUS  I. 

With  decreased  Actions  of  the  Muscles 


J.  Lassitudo 

2.  Vacillatio  senilis 

3.  Tremor  senilis 

4.  Brachiorum  paralysis 

5.  Raucedo  paralytica 

6.  Vesica  urinaria  paralysis 

7.  Recti  paralysis 

8.  Paresis  voluntaria 

9.  Catalepsis 

10.  Hemiplegia 

11.  Paraplegia 

12.  Somnus 

13.  Incubus 

14.  Lethargus 

15.  Syncope  epileptica 

16.  Apoplexia 

17.  Mors  a f rigor e 


SPECIES. 

Fatigue 

See-saw  of  old  age 
Tremor  of  old  age 
Palsy  of  the  arms 
Paralytic  hoarseness 
Palsy  of  the  bladder 
Palsy  of  the  rectum 
Voluntary  debility 
Catalepsy 
Palsy  of  one  side 
Palsy  of  the  lower  limbs 
Sleep 

Night-mare 
Lethargy 
Epilepiic  fainting 
Apoplexy 
Death  from  cold 


GENUS  II. 

With  decreased  Actions  of  the  Organs  of  Sense 
SPECIES. 


1.  Recollectionis  jactura 

2.  Stultitia  voluntaria 

3.  Credulitas 


Loss  of  recollection 
Voluntary  folly 
Credulity 


Class  IH.  1. 1. 


OF  VOLITION. 


27  5 


CLASS  III. 

DISEASES  OF  VOLITION. 

ORDO  I. 

Increased  Volition. 

GENUS  I. 

With  increased  Jldions  of  the  Muscles. 

We  now  step  forward  to  consider  the  diseases  of  volition, 
that  superior  faculty  of  the  sensorium,  which  gives  us  the  power 
of  reason,  and  by  its  facility  of  action  distinguishes  mankind 
from  brute  animals;  which  has  effected  all  that  is  great  in  the 
world,  and  superimposed  the  works  of  art  on  the  situations  of 
nature. 

Pain  is  introduced  into  the  system  either  by  excess  or  defect 
of  the  action  of  the  part.  (Sect.  IV.  5.)  Both  which  circum- 
stances seem  to  originate  from  the  accumulation  of  sensorial 
power  in  the  affected  organ.  Thus  when  the  skin  is  exposed  to 
great  cold,  the  activity  of  the  cutaneous  vessels  is  diminished,  and 
in  consequence  an  accumulation  of  sensorial  power  obtains  in 
them,  because  they  are  usually  excited  into  incessant  motion  by 
the  stimulus  of  heat,  as  explained  in  Sect.  XII.  5.  2.  Contrary- 
wise,  when  the  vessels  of  the  skin  are  exposed  to  great  heat,  an 
excess  of  sensorial  power  is  also  produced  in  them,  which  is  de- 
rived thither  by  the  increase  of  stimulus  above  what  is  natural. 

This  accounts  for  the  relief  which  is  received  in  all  kinds  of 
pain  by  any  violent  exertions  of  our  muscles  or  organs  of  sense; 
which  may  thus  be  in  part  ascribed  to  the  exhaustion  of  the  sen- 
sorial power  by  such  exertions.  But  this  relief  is  in  many  cases 
so  instantaneous,  that  it  seems  nevertheless  probable,  that  it  is 
also  in  part  owing  to  the  different  manner  of  progression  of  thq 
two  sensorial  powers  of  sensation  and  volition;  one  of  them  com- 
mencing at  some  extremity  of  the  sensorium,  and  being  propa- 
gated towards  the  central  parts  of  it;  and  the  other  commencing 
in  the  central  parts  of  the  sensorium,  and  being  propagated  to- 
wards the  extremities  of  it;  as  mentioned  in  Sect.  XI.  2.  1. 

These  violent  voluntary  exertions  of  our  muscles  or  ideas  to 
relieve  the  sensation  of  pain  constitute  convulsions  and  madness; 
and  are  distinguished  from  the  muscular  actions  owing  to  in- 
creased sensation,  as  in  sneezing,  or  coughing,  or  parturition,  or 


276 


DISEASES 


Class  III.  1.  1. 


ejectio  seminis,  because  they  do  not  contribute  to  dislodge  the 
cause,  but  only  to  prevent  the  sensation  of  it.  In  two  cases  of  ‘ 
parturition,  both  of  young  women  with  their  first  child,  1 have 
seen  general  convulsions  occur  from  excess  of  voluntary  exer- 
tion as  above  described,  instead  of  the  actions  of  particular  mus- 
cles, which  ought  to  have  been  excited  by  sensation  for  the  ex- 
clusion of  the  fetus.  They  both  became  insensible,  and  died 
after  some  hours;  from  one  of  them  the  fetus  was  extracted  in 
vain.  I have  heard  also  of  general  convulsions  being  excited 
instead  of  the  actions  of  the  musculi  acceleratores  in  the  ejectio 
seminis,  which  terminated  fatally.  See  Class  III.  1.  1.  7. 

These  violent  exertions  are  most  frequently  excited  in  con- 
sequence of  those  pains,  which  originate  from  defect  of  the 
action  of  the  part.  See  Sect.  XXXIV.  1.  and  2.  The  pains 
from  excess  and  defect  of  the  action  of  the  part  are  distin- 
guishable from  each  other  by  the  former  being  attended  w ith 
increase  of  heat  in  the  pained  part,  or  of  the  whole  body; 
while  the  latter  not  only  exist  without  increase  of  heat  in  the 
pained  part,  but  are  generally  attended  w ith  coldness  of  the  ex- 
tremities of  the  body. 

As  soon  as  these  violent  actions  of  our  muscular  or  sensual 
fibres  for  the  purpose  of  relieving  pain  cease  to  be  exerted,  the 
pain  recurs;  whence  the  reciprocal  contraction  and  relaxation 
of  the  muscles  in  convulsion,  and  the  intervals  of  madness. 
Otherwise  these  violent  exertions  continue,  till  so  great  a part  of 
the  sensorial  power  is  exhausted,  that  no  more  of  it  is  excitable 
by  the  faculty  of  volition;  and  a temporary  apoplexy  succeeds, 
with  snoring  as  in  profound  sleep;  which  so  generally  terminates 
epileptic  fits. 

When  these  voluntary  exertions  become  so  connected  with 
certain  disagreeable  sensations,  or  with  irritations,  that  the  ef- 
fort of  the  will  cannot  restrain  them,  they  can  no  longer  in  com- 
mon language  be  termed  voluntary;  but,  nevertheless,  belong  to 
this  class,  as  they  are  produced  by  excess  of  volition,  and  may 
slid  not  improperly  be  called  depraved  voluntary  actions.  See 
Sect.  XXXIV.  1.  where  many  motions,  in  common  language 
termed  involuntary,  are  shewn  to  depend  on  excess  of  volition. 

When  these  exertions  from  excess  of  volition,  w’hich  in  com- 
mon language  are  termed  involuntary  motions,  either  of  mind 
or  body,  are  perpetually  exerted  in  weak  constitutions,  the  pulse 
becomes  quick;  w'hich  is  occasioned  by  the  too  great  expendi- 
ture of  the  sensorial  power  in  these  unceasing  modes  of  activity. 
In  the  same  manner  as  in  very  weak  people  in  fevers,  the  pulse 
sometimes  increases  in  frequency  to  140  strokes  in  a minute, 
when  the  patients  stand  up  or  endeavour  to  walk;  and  subsides 


ClASS  III.  1.  1. 


OF  VOLITION; 


211 

to  110,  when  they  lie  down  again  in  their  beds.  Whence  it 
Appears,  that  when  a very  quick  pulse  accompanies  convulsion 
or  insanity,  it  simply  indicates  the  weakness  of  the  patient;  that 
is,  that  the  expenditure  of  sensorial  power  is  too  great  for  the 
supply  of  it.  But  if  the  strength  of  the  patient  is  not  previously 
exhausted,  the  exertions  of  the  muscles  are  attended  with  tem- 
porary increase  of  circulation,  the  reciprocal  swellings  and  elon- 
gations of  their  bellies  push  forwards  the  arterial  blood,  and 
promote  the  absorption  of  the  venous  blood;  whence  a tempo- 
rary increase  of  secretion  and  of  heat,  and  a stronger  pulse. 

A correspondent  acquaints  me,  that  he  finds  difficulty  in  un- 
derstanding how  the  convulsions  of  the  limbs  in  epilepsy  can  be 
induced  by  voluntary  exertions.  This  I suspept,  first  to  have 
arisen  from  the  double  meaning  of  the  words  “ involuntary  mo- 
tions;” which  are  sometimes  used  for  those  motions,  which  are 
performed  without  the  interference  of  volition,  as  the  pulsations 
of  the  heart  and  arteries;  and  at  other  times  for  those  actions, 
which  occur,  where  two  counter  volitions  oppose  each  other, 
and  the  stronger  prevails;  as  in  endeavouring  to  suppress  laugh- 
ter, and  to  stop  the  shudderings  when  exposed  to  cold.  Thus 
w'hen  the  poet  writes, 

video  meliora,  proboque, 

IJeteriora  sequor. 

The  stronger  volition  actuates  the  system,  but  not  without  the 
counteraction  of  unavailing  smaller  ones;  which  constitute  de- 
liberation. 

A second  difficulty  may  have  arisen  from  the  confined  use  of 
the  words  “ to  will,”  which  in  common  discourse  generally 
mean  to  choose  after  deliberation;  and  hence  our  will  or  voli- 
tion is  supposed  to  be  always  in  our  own  power.  But  the  will 
or  voluntary  powers,  act  ahvav  from  motive,  as  explained  in 
Sect.  XXXIV.  1.  and  in  Class' IV.  1.  3.  2.  and  III.  2.  1.  12. 
which  motive  can  frequently  be  examined  previous  to  action, 
and  balanced  against  opposite  motives,  which  is  called  delibera- 
tion; at  other  times  the  motive  is  so  powerful  as  immediately 
to  excite  the  sensorial  power  of  volition  into  action,  without  a 
previous  balancing  of  opposite  motives,  or  counter  volitions. 
The  former  of  these  volitions  is  exercised  in  the  common  pur- 
poses of  life,  and  the  latter  in  the  exertions  of  epilepsy  and  in- 
sanity. 

It  is  difficult  to  think  without  words , which  however  all  those 
must  do,  who  discover  new  truths  by  reasoning;  and  still  more 
difficult,  when  the  words  in  common  use  deceive  us  by  theft 

( 


UISEAStiS 


Glass  III  1.  1.  1. 


278 

twofold  meanings,  or  by  the  inaccuracy  of  the  ideas  which  thev 
suggest. 

SPECIES. 

1.  Jactitatio.  Restlessness.  There  is  one  kind  of  restlessness 
attending  fevers,  which  consists  in  a frequent  change  of  posture 
to  relieve  the  uneasiness  of  the  pressure  of  one  part  of  the  body 
upon  another,  when  the  sensibility  of  the  system,  or  of  some 
parts  of  it,  is  increased  by  inflammation,  as  in  the  lumbago; 
which  may  sometimes  be  distinguished  in  its  early  stage  by  the 
incessant  desire  of  the  patient  to  turn  himself  in  bed.  But  there 
is  another  restlessness,  which  approaches  towards  writhing  or 
contortions  of  the  body,  which  is  a voluntary  etfort  to  relieve 
pain;  and  may  be  esteemed  a slighter  kind  of  convulsion,  not 
totally  unrestrainable  by  opposite  or  counteracting  volitions. 

Thus  when  a squirrel  is  confined  in  a cage,  he  feels  uneasi- 
ness from  the  accumulation  of  sensorial  potver,  in  his  muscles, 
which  were  before  in  continual  violent  exertion  in  his  habits 
ofiife;  and  in  this  situation  finds  relief  by  perpetually  jump- 
ing about  his  cage  to  expend  a part  of  this  accumulated  senso- 
rial power. 

For  the  same  reason  those  children  who  are  constrained  to  sit 
in  some  schools  for  hours  together,  are  liable  to  acquire habbs  of 
moving  some  muscles  of  their  faces,  or  hands,  or  feet,  which  are 
called  tricks,  to  exhaust  a part  of  the  accumulated  sensorial 
powder.  Hence  restlessness  is  occasioned  by  increase  of  stimulus, 
or  by  accumulation  of  sensorial  power. 

M.  M.  A blister.  Opium.  Warm  bath.  Bandage  on  the 
moving  muscles.  See  Convulsio  debiiis,  Class  III.  1.  1.  5. 
exercise. 

2.  Tremor  febrilis.  Reciprocal  convulsions  of  the  subcu- 
taneous muscles,  originating  from  the  pain  of  the  sense  of 
heat,  owing  to  defect  of  its  usual  stimulus,  and  consequent 
accumulation  of  sensorial  power  in  it.  The  actual  deficiency 
of  heat  may  exist  in  one  part  of  the  body,  and  the  pain  of 
cold  be  felt  most  vividly  in  some  other  part  associated  with 
it  by  sensitive  sympathy.  So  a chilness  down  the  back  is  first 
attended  to  in  ague  fits,  though  the  disease  perhaps  commences 
with  the  torpor  and  consequent  coldness  of  some  internal  vis- 
cus.  But  in  whatever  part  of  the  system  the  defect  of  heat 
exists,  or  the  sensation  of  it,  the  convulsions  of  the  subcu- 
taneous muscles  exerted  to  relieve  it  are  very  general;  and,  if 
the  pain  is  still  greater,  a chattering  of  the  teeth  is  added,  the 


OP  VOLITION. 


©iass  m.  1. 1.  s. 


279 


more  suddenly  to  exhaust  the  sensorial  power,  and  because  the 
teeth  are  very  sensible  to  cold. 

These  convulsive  motions  are  nevertheless  restrainable  by  vio- 
lent voluntary  counteraction;  and  as  their  intervals  are  owing 
to  the  pain  of  cold  being  for  a time  relieved  by  their  exertion, 
they  may  be  compared  to  laughter,  except  that  there  is  no  in- 
terval of  pleasure  preceding  each  moment  of  pain  in  this  as  ia 
the  latter. 

MM.  Seel.  2.  2.1. 

3.  Clamor.  Screaming  from  pain.  Tlie  talkative  animals, 
as  dogs,  and  swine,  and  children,  scream  most,  when  they  are  in 
pain,  and  even  from  fear;  as  they  have  used  this  kind  of  exer- 
tion from  their  birth  most  frequently  and  most  forcibly;  and 
can  therefore  sooner  exhaust  the  accumulation  of  sensorial  power 
in  the  affected  muscular  or  sensual  organs  by  this  mode  of 
exertion;  as  described  in  Sect.  XXXIV.  1.  3.  This  facility  of 
relieving  pain  by  screaming  is  the  source  of  laughter,  as  explain- 
ed below. 

4.  Rims.  The  pleasurable  sensations,  which  occasion  laugh- 
ter are  perpetually  passing  into  the  bounds  of  pain;  for  pleasure 
and  pain  are  often  produced  by  different  degrees  of  the  same 
stimulus;  as  warmth,  light,  aromatic  or  volatile  odours,  become 
painful  by  their  excess;  and  the  tickling  on  the  soles  of  the  feet 
in  children  is  a painful  sensation  at  the  very  time  it  produces 
laughter.  When  the  pleasurable  ideas,  which  excite  us  to  laugh, 
pass  into  pain,  wre  use  some  exertion,  as  a scream,  to  relieve  the 
pain,  but  soon  stop  it  again,  as  we  are  unwilling  to  lose  the 
pleasure;  and  thus  we  repeatedly  begin  to  scream,  and  stop  again 
alternately.  So  that  in  laughing  there  are  three  stages,  first  of 
pleasure,  then  pain,  then  an  exertion  to  relieve  that  pain.  See 
Sect.  XXXIV.  1.  3. 

Every  one  has  been  in  a situation,  where  some  ludicrous  cir- 
cumstance has  excited  him  to  laugh;  and  at  the  same  time  a 
sense  of  decorum  has  forbid  the  exertion  of  these  interrupted 
screams;  and  then  the  pain  has  become  so  violent,  as  to  occa- 
sion him  to  use  some  other  great  action,  as  biting  his  tongue,  and 
pinching  himself,  in  lieu  of  the  reiterated  screams  which  consti- 
tute laughter. 

5 Convulsio.  Convulsion.  When  the  pains  from  defect  or 
excess  of  motion  are  more  distressing  than  those  already  describ- 
ed, and  are  not  relievable  by  such  partial  exertions,  as  in  scream- 
ing,  or  laughter,  more  general  convulsions  occur;  which  vary 
perhaps  according  to  the  situation  of  the  pained  part,  or  to  some 
previous  associations  formed  by  the  early  habits  of  life.  When 
these  convulsive  motions  bend  the  body  forwards,  they  are  termed 


DISEASES 


Class  ffl.  1. 1.  5. 


§80 

emprosthotonoi;  when  they  bend  it  backward,  they  are  termed 
opisthotonoi.  They  frequently  succeed  each  other,  but  the 
opisthotonoi  are  generally  more  violent;  as  the  muscles,  which 
erect  the  body,  and  keep  it  erect,  are  naturally  in  more  constant 
and  more  forcible  action  than  their  antagonists. 

The  causes  of  convulsion  are  very  numerous,  as  from  tooth- 
ing in  children,  from  worms  or  acidity  in  their  bowels,  from 
eruption  of  the  distinct  small-pox,  and  lastly,  from  breathing 
too  long  the  air  of  an  unventilated  bed-room.  Sir  G.  Baker, 
in  the  Transactions  of  the  College,  described  this  disease,  and 
detected  its  cause;  where  many  children  in  an  orphan-house 
were  crowded  together  in  one  chamber  without  a chimney,  and 
were  almost  all  of  them  affected  with  convulsion;  in  the  hos- 
pital at  Dublin,  many  died  of  convulsions  before  the  real  cause 
was  understood.  See  Dr.  Beddoes’  Guide  to  Self-preservation. 
In  a large  family  which  I attended,  where  many  female  servants 
slept  in  one  room,  which  they  had  contrived  to  render  inacces- 
sible to  every  blast  of  air;  I saw  four  who  were  thus  seized  with 
convulsions,  and  who  were  believed  to  have  been  affected  by 
sympathy  from  the  first  who  fell  ill.  They  were  removed  into 
more  airy  apartments,  but  were  some  weeks  before  they  all  re- 
gained their  perfect  health. 

Convulsion  is  distinguished  from  epilepsy,  as  the  patient  does 
not  entirely  lose  all  perception  during  the  paroxysm.  Whjch 
only  shews,  that  a less  exhaustion  of  sensorial  power  renders  to- 
lerable the  pains  which  cause  convulsion,  than  those  which  cause 
epilepsy.  The  hysteric  convulsions  are  distinguished  from  those 
owing  to  other  causes,  by  the  preference  of  the  expectation  of 
death,  which  precedes  and  succeeds  them,  and  generally  by  a 
flow  of  pale  urine;  these  convulsions  do  not  constantly  attend 
the  hysteric  disease,  but  are  occasionally  superinduced  by  the 
disagreeable  sensation  arising  from  the  torpor  or  inversion  of  a 
part  of  the  alimentary  canal.  Whence  the  convulsion  of  laugh- 
ter is  frequently  sufficient  to  restrain  these  hysteric  pains,  which 
accounts  for  the  fits  of  laughter  frequently  attendant  on  this 
disease. 

M.  M.  To  remove  the  peculiar  pain  which  excites  the  con- 
vulsions. Venesection.  An  emetic.  A cathartic  with  calo- 
mel. Warm-bath.  Opium  in  large  quantities,  beginning  with 
smaller  ones.  Mercurial  frictions.  Electricity.  Cold-bath  in 
the  paroxysm;  or  cold  aspersion.  See  Memoirs  of  Med.  Society, 
Lon.  Vol.  III.  p.  147,  a paper  by  Dr.  Currie. 

5.  Convulsio  debilis.  The  convulsions  of  dying  animals,  as  of 
those  which  are  bleeding  to  death  iu  the  slaughter-house,  are  an 
effort  to  relieve  painful  sensation,  either  of  the  wound  which 


<5i,ass  HI.  1. 1.  6. 


OF  VOLITION. 


281 


occasions  their  death,  or  of  faintness  from  want  of  due  disten* 
tion  of  the  blood  vessels.  Similar  to  this  in  a less  degree  is  the 
subsultus  tendinuni,  or  starting  of  the  tendons,  in  fevers  with  de- 
bility; these  actions  of  the  muscles  are  too  weak  to  move  the 
limb,  but  the  belly  of  the  acting  muscles  is  seen  to  swell,  and 
the  tendon  to  be  stretched.  These  weak  convulsions,  as  they 
are  occasioned  by  the  disagreeable  sensation  of  faintness  from 
inanition,  are  symptoms  of  great  general  debility,  and  thence 
frequently  precede  the  general  convulsions  of  the  act  of  dying. 
See  a case  of  convulsion  of  a muscle  of  the  arm,  and  of  the  fore- 
arm, without  moving  the  bones  to  which  they  were  attached, 
Sect.  XVII.  1.  8.  See  tvvitchings  of  the  face,  Class  IV.  1.  3.  2. 

6.  Convulsio  dolorijica.  Raphania.  Painful  convulsion.  In 
this  disease  the  muscles  of  the  arms  and  legs  are  exerted  to  re- 
lieve the  pains  left  after  the  rheumatism  in  young  and  delicate 
people;  it  recurs  once  or  twice  a day,  and  has  been  mistaken  for 
the  chorea,  or  St.  Vituses  dance;  but  differs  from  it,  as  the  un- 
due motions  in  that  disease  only  occur,  when  the  patient  endea- 
vours to  exert  the  natural  ones;  are  not  attended  with  pain;  and 
cease  when  he  lies  down  without  trying  to  move:  the  chorea, 
or  dance  of  St.  Vitus,  is  often  introduced  by  the  itch,  this  by  the 
rheumatism. 

It  has  also  been  improperly  called  nervous  rheumatism;  but 
is  distinguished  from  rheumatism,  as  the  pains  recur  by  peri- 
ods once  or  twice  a day;  whereas  in  the  chronic  rheumatism 
they  only  occur  on  moving  the  affected  muscles.  And  by  the 
warmth  of  a bed  the  pains  of  the  chronic  rheumatism  are  in- 
creased, as  the  muscles  or  membranes  then  become  more  sensi- 
ble to  the  stimulus  of  the  extraneous  mucaginous  material  de- 
posited under  them.  Whereas  the  pains  of  the  raphania,  or 
painful  convulsion,  commence  with  coldness  of  the  part,  or 
of  the  extremities.  See  Rheumatismus  chronicus.  Class  I. 
1.  3.  12. 

The  pains  which  accompany  the  contractions  of  the  muscles 
in  this  disease,  seem  to  arise  from  the  too  great  violence  of  those 
contractions,  as  happens  in  the  cramp  of  the  calf  of  the  leg; 
from  which  they  differ  in  those  being  fixed,  and  these  being  re- 
iterated contractions.  Thus  these  convulsions  are  generally  of 
the  lower  limbs,  and  recur  at  periodical  times  from  some  uneasy 
sensation  from  defect  of  action,  like  other  periodic  diseases; 
and  the  convulsions  of  the  limbs  relieve  the  original  uneasy  pain- 
ful sensation,  and  then  produce  a greater  pain  from  their  own 
too  vehement  contractions.  There  is  however  another  way  of 
accounting  for  these  pains,  when  they  succeed  the  acute  rheu- 
matism; and  that  is  by  the  coagulable  lymph,  which  may  be  left 

VOL.  It.  o o 


rm 


DISEASES 


Glass  lit.  1.  1.  7. 


still  unabsorbed  on  the  membranes;  and  which  may  be  in  too 
small  quantity  to  affect  them  with  pain  in  common  muscular 
exertions,  but  may  produce  great  pain,  when  the  bellies  of  the 
muscles  swell  to  a larger  bulk  in  violent  action. 

M.  M.  Venesection.  Calomel.  Opium.  Bark.  One  grain 
of  calomel  and  one  of  opium  for  ten  successive  nights.  A ban- 
dage spread  with  emplasirum  de  minio  put  tight  on  the  affected 
part. 

7.  Epilepsia  is  originally  induced,  like  other  convulsions,  by  a 
voluntary  exertion  to  relieve  some  pain.  This  pain  is  most  fre- 
quently about  the  pit  of  the  stomach,  or  termination  of  the  bile- 
duct;  and  in  some  cases  the  torpor  of  the  stomach,  which  pro- 
bably occasioned  the  epileptic  fits,  remains  afterwards,  and  pro- 
duces a chronical  anorexia;  of  which  a case  is  related  in  Class 
II.  2.  2.  1.  There  are  instances  of  its  beginning  in  the  heel, 
of  which  a case  is  published  by  Dr.  Short,  in  the  Med.  Essays, 
Edin.  I once  saw  a child  about  ten  years  old,  who  frequently 
fell  down  in  convulsions,  as  she  was  running  about  in  play;  on 
examination,  a wart  was  found  on  one  ancle,  which  was  ragged 
and  intlamed;  which  was  directed  to  be  cut  off,  and  the  fits 
never  recurred. 

When  epilepsy  first  commences,  the  patients  are  liable  to  ut- 
ter one  scream  before  they  fall  down;  afterwards  the  convul- 
sions so  immediately  follow  the  pain,  which  occasions  them, 
that  the  patient  does  not  recollect  or  seem  sensible  of  the  pre- 
ceding pain.  Thus  in  laughter,  when  it  is  not  excessive,  a per- 
son is  not  conscious  of  the  pain,  which  so  often  recurs,  and  causes 
the  successive  screams  or  exertions  of  laughter,  which  give  a 
temporary  relief  to  it. 

Epileptic  fits  frequently  recur  in  sleep  from  the  increase  of 
sensibility  at  that  time,  explained  in  Sect.  XVIII.  14.  In  two 
such  cases,  both  of  young  women,  one  grain  of  opium  given  at 
night  and  continued  many  months,  had  success;  in  one  of  them 
the  opium  w'as  omitted  twice  at  different  times,  and  the  fit  re- 
curred on  both  the  nights.  In  the  more  violent  case,  described 
in  Sect.  XVIII.  15,  opium  had  no  effect. 

Epileptic  fits  generally  commence  with  setting  the  teeth,  by 
which  means  the  tongue  is  frequently  wounded;  and  with  roll- 
ing the  eye-balls  in  every  kind  of  direction;  for  the  muscles 
which  suspend  the  jaw,  as  well  as  those  which  move  the  eyes, 
are  in  perpetual  motion  during  our  waking  hours;  and  yet  con- 
tinue subservient  to  volition;  hence  their  more  facile  and  forci- 
ble actions  for  the  purpose  of  relieving  pain  by  the  exhaustion 
of  sensorial  power.  See  Section  XXXIV.  1 . 4. 

Epileptic  convulsions  are  not  attended  with  the  fear  of  death. 


Ceass  III.  1.  1.  7. 


OF  VOLITION. 


283 


as  in  the  hysteric  disease,  and  the  urine  is  of  a straw  colour. 
However  it  must  be  noted,  that  the  disagreeable  sensations  in 
hysteric  diseases  sometimes  are  the  cause  of  true  epileptic  con* 
vulsions,  of  syncope,  and  of  madness. 

The  pain,  which  occasions  some  fits  of  epilepsy,  is  felt  for  a 
time  in  a distant  part  of  the  system,  as  in  a toe  or  heel;  and  is 
said  by  the  patient  gradually  to  ascend  to  the  head,  before  the 
general  convulsions  commence.  This  ascending  sensation  has 
been  called  aura  epileptica,  and  is  said  to.  have  been  prevented 
from  affectiug  the  head  by  a tight  bandage  round  the  limb.  In 
this  malady  the  pain,  probably  of  some  torpid  membrane,  or  dis- 
eased tendon,  is  at  first  only  so  great  as  to  induce  slight  spasms 
of  the  muscular  fibres  in  its  vicinity;  which  slight  spasms  cease 
on  the  numbness  introduced  by  a tight  bandage;  when  no  band- 
age is  applied,  the  pain  gradually  increases,  till  general  convul- 
sions are  exerted  to  relieve  it.  The  course  of  a lymphatic,  as 
when  poisonous  matter  is  absorbed;  or  of  a nerve,  as  in  the 
sciatica,  may,  by  the  sympathy  existing  between  their  extre- 
mities and  origins,  give  an  idea  of  the  ascent  of  an  aura  or  va- 
pour. 

In  difficult  parturition  it  sometimes  happens,  that  general  con- 
vulsions are  excited  to  relieve  the  pain  of  labour,  instead  of  the 
exertions  of  those  muscles  of  the  abdomen  and  diaphragm,  which 
ought  to  forward  the  exclusion  of  the  child.  See  Class  III.  1.  1. 
That  is,  instead  of  the  particular  muscular  actions,  which  ought 
to  be  excited  by  sensation  to  remove  the  offending  cause,  general 
convulsions  are  produced  by  the  power  of  volition,  which  still  the 
pain,  as  in  common  epilepsy,  without  removing  the  cause;  and 
as  the  parturition  is  not  thus  promoted,  the  convulsions  continue, 
till  the  sensorial  power  is  totally  exhausted,  that  is,  till  death.  In 
patients  afflicted  with  epilepsy  from  other  causes,  I have  seen 
the  most  violent  convulsions  recur  frequently  during  pregnancy 
without  miscarriage;  as  they  did  not  tend  to  forward  the  exclusion 
of  the  fetus. 

Pains  of  this  kind  have  been  called  false  pains  by  some  writers 
on  midwifery,  and  are  directed  to  be  relieved  by  an  opiate,  and 
then  they  say  the  true  pains  will  commence.  M.  Daventer  di- 
rects the  accoucheur  to  attend  to  the  os  tincae,  to  distinguish  them 
from  each  other,  which  dilates  with  every  true  pain,  but  contracts 
with  every  false  one,  that  is,  the  voluntary  actions  of  other  mus- 
cles to  relieve  pain  are  attended  with  those  of  the  os  uteri,  as 
mentioned  in  Genus  I.  of  this  Class  and  Order  preceding  the 
descriptions  of  the  Species. 

M.  M.  Venesection.  A large  dose  of  opium.  Delivery. 

The  later  in  life  epileptic  fits  are  first  experienced,  the  more 


284 


DISEASES 


Class  III.  1.  1.  7. 


dangerous  they  may  be  esteemed  in  general;  as  in  these  eases 
the  cause  has  generally  been  acquired  by  the  habits  of  the  patient, 
or  by  the  decay  of  some  part,  and  is  thus  probably  in  an  increas- 
ing state.  Whereas  in  children  the  change  in  the  system,  as  they 
advance  to  puberty,  sometimes  removes  the  cause.  So  in  tooth- 
ing, fits  of  convulsion  with  stupor  frequently  occur,  and  cease 
when  the  tooth  advances;  but  this  is  not  to  be  expected  in  ad- 
vanced life.  Sir , about  sixty  years  of  age,  had  only 

three  teeth  left  in  his  upper  jaw,  a canine  tooth,  and  one  on  each 
side  of  it.  He  was  seized  with  epileptic  fits,  with  pain  com- 
mencing in  these  teeth.  He  was  urged  to  have  them  extracted, 
which  he  delayed  too  long,  till  the  fits  were  become  habitual, 
and  then  had  them  extracted  in  vain,  and  in  a few  mouths 
sunk  under  the  disease. 

Mr.  H.  M.  was  seized  with  pain  in  the  adductor  muscle  of 
the  right  thumb,  and  had  epileptic  convulsions  in  consequence; 
these  gradually  increased  in  strength  and  frequency;  a bandage 
on  the  arm,  drawn  very  tight  as  soon  as  the  pain  of  the  ball  of 
the  thumb  commenced,  prevented  the  epileptic  fits,  1 suppose 
by  lessening  the  pain  by  the  numbness  occasioned  by  compressing 
the  nerve.  1 advised  the  nerves  of  this  muscle  to  be  cut,  which 
was  done  or  attempted,  and  was  supposed  for  a time  to  have 
cured  the  disease,  as  I was  informed.  Afterwards  it  recurred 
and  destroyed  the  patient,  who  might  have  probably  been  saved 
by  the  loss  of  a hand,  which  I should  have  advised,  but  was  not 
again  consulted. 

I have  to  add,  that  the’  tic  doloureux,  or  hemicrania  idio- 
pathica,  I believe  to  be  a disease  of  this  kind,  owing  to  a torpor 
of  the  extremity  of  some  branch  of  a nerve,  and  should  recom- 
mend, when  the  nerve  cannot  be  bisected,  to  pass  through  it 
for  many  hours  or  even  days,  a current  of  galvanic  electricity 
from  Volta’s  pillar  of  zinc,  and  silver,  and  cloth  moistened  with 
salt  and  water. 

Mr.  F , who  had  lived  intemperately,  and  had  been  oc- 

casionally affected  with  the  gout,  was  suddenly  seized  with  epi- 
leptic fits;  the  convulsions  were  succeeded  by  apoplectic  snor- 
ing; from  which  he  was,  in  about  20  minutes,  disturbed  by 
fresh  convulsions,  and  had  continued  in  this  situation  above  four- 
and-twenty  hours.  About  eight  ounces  of  blood  were  then  taken 
from  him:  and  after  having  observed,  that  the  apoplectic  tor- 
por continued  about  20  minutes,  I directed  him  to  be  forcibly  rais- 
ed up  in  bed,  after  he  had  thus  lain  about  fifteen  minutes,  to  gain 
an  interval  between  the  termination  of  the  sleep,  and  the  renova- 
tion of  convulsion.  In  this  interval  he  was  induced  to  swal- 
low forty  drops  of  laudanum.  Twenty  more  were  given  him 


Ciass  III.  1.  1.  7. 


of  Volition. 


285 

in  the  same  manner  in  about  half  an  hour,  both  which  evidently 
shortened  the  convulsion  fits,  and  the  consequent  stupor;  he 
then  took  thirty  more  drops,  which  for  the  present  removed  the 
fits.  He  became  rather  insane  the  next  day,  and  after  about 
three  more  days  lost  the  insanity,  and  recovered  his  usual  state 
of  health. 

The  case  mentioned  in  Sect.  XXVII.  2.  where  the  patient  was 
left  after  epileptic  fits  with  a suffusion  of  blood  beneath  the  tunica 
adjunctiva  of  the  eye,  was  in  almost  every  respect  similar  to  the 
preceding,  and  submitted  to  the  same  treatment.  Both  of  them 
suffered  frequent  relapses,  which  were  relieved  by  the  same 
means,  and  at  length  perished,  I believe,  by  the  epileptic  fits. 

In  those  patients,  who  have  not  been  subject  to  epilepsy  be- 
fore they  have  arrived  to  about  forty  years  of  age,  and  who 
have  been  intemperate  in  respect  to  spirituous  potation,  1 have 
been  induced  to  believe,  that  the  fits  were  occasioned  by  th ; 
pain  of  a diseased  liver;  and  this  became  more  probable  in  one 
of  the  above  subjects,  who  had  used  means  to  repel  eruptions 
on  the  face;  and  thus  by  some  stimulant  application  had  pre- 
vented an  inflammation  taking  place  on  the  skin  of  the  face  in- 
stead of  on  some  part  of  the  liver.  Secondly,  as  in  these  cases  in- 
sanity had  repeatedly  occurred,  w'hich  could  not  be  traced  from 
an  hereditary  source;  there  is  reason  to  believe,  that  this  as  well 
as  the  epileptic  convulsions  were  caused  by  spirituous  potation; 
and  that  this  therefore  is  the  original  source  both  of  epilepsy  and 
of  insanity  in  those  families,  which  are  afflicted  with  them.  This 
idea  however  brings  some  consolation  with  it;  as  it  may  be  in- 
ferred, that  in  a few  sober  generations  these  diseases  may  be  era- 
dicated, which  otherwise  destroy  the  family. 

M.  M.  Venesection.  Opium.  Bark.  Steel.  Arsenic.  Opium 
one  grain  twice  a day  for  years  together.  See  the  preceding  ar- 
ticle, and  the  succeeding  one. 

Jlnorexia  epileptica , as  mentioned  in  Class  II.  2.  2.  1.  is  a 
dreadful  disease,  originating  I believe,  from  a paralysis  of  the 
stomach,  and  generally  occasioned  by  the  application  of  great  ex- 
ternal cold  to  the  skin.  A young  lady,  whom  I saw  yesterday* 
who  had  long  experienced  a weak  state  of  health,  went  to  church 
on  an  uncommonly  cold  Sunday,  when  the  thermometer  wTas  said 
to  stand  below  20  during  the  whole  day.  She  became  immedi- 
ately indisposed,  and  was  seized  in  a day  or  two  with  tremors 
and  convulsions  in  her  sleep;  and  which  returned  every  two  or 
three  days.  Her  extremities  are  now  always  uncommonly  cold, 
and  her  appetite  to  food  totally  defective.  She  took  three  drops 
of  a saturated  solution  of  arsenic  and  a bitter  draught  twice  a day 
for  a fortnight,  and  gradually  recovered  her  former  state  of  health. 


286 


DISEASES 


Glass  III.  1.  1.  S. 


Another  young  lady,  whom  I lately  saw,  began  to  start  some- 
what like  a violent  hiccough  many  times  in  an  hour,  after  using 
a very  cold  shower-bath  repeatedly.  This  had  continued  daily 
at  uncertain  times  for  many  months,  and  received  temporary 
advantage  from  one  drop  of  oil  of  cinnamon,  three  or  four 
times  a day,  on  powdered  sugar;  this  case  belongs  to  convulsion 
rather  than  epilepsy,  but  was  attended  like  the  former,  with 
great  defect  of  appetite.  In  both  these  cases  I suspect,  that  the 
great  torpor  of  the  stomach  was  caused  by  too  violent  or  too 
long  continued  coldness  applied  to  the  skin;  whence  the  senso- 
rial power  of  association,  which  ought  to  have  been  excited  by 
the  action  of  the  cutaneous  vessels,  and  to  have  then  contributed 
to  the  action  of  the  stomach,  did  not  exist;  and  that  the  stomach 
in  consequence  became  torpid.  See  Suppl.  I.  14.  3.  and  Art. 
IV.  2.  6.  8.  and  Class  III.  2.  1.  17. 

Dr.  Wilson,  of  Spalding,  has  lately  much  recommended  the 
argentum  nitratum  in  epilepsy;  he  gives  two  grains  and  a half 
three  times  a day,  mixed  with  bread  crumbs  into  pills,  as  he  as- 
serts, with  the  happiest  success.  Annals  of  Medicine,  1797. 

8.  Epilepsia  dolorifica.  Painful  epilepsy.  In  the  common 
epilepsy  the  convulsions  are  immediately  induced,  as  soon  as  the 
disagreeable  sensation  which  causes  them,  commences;  but  in 
this  the  pain  continues  long  with  cold  extremities,  gradually  in- 
creasing for  two  or  three  hours,  till  at  length  convulsions  or  mad- 
ness come  on;  which  terminate  the  daily  paroxysm,  and  cease 
themselves  in  a little  time  afterwards. 

This  disease  sometimes  originates  from  a pain  about  the  lower 
edge  of  the  liver,  sometimes  in  the  temple,  and  sometimes  in  the 
pudendum;  it  recurs  daily  for  five  or  six  weeks,  and  then  ceases 
for  several  months.  The  pain  is  owing  to  defect  of  action,  that 
is,  to  the  accumulation  of  sensorial  power  in  the  part,  which  pro- 
bably svmpathizes  with  some  other  part,  as  explained  in  Sect. 
XXXV .'2.  XII.  5.  3.  and  Class  II.  1.  1.  11.  and  IV.  2 2.  3. 

It  is  the  most  painful  maladv  that  human  nature  is  liable  to! — 
See  Sect.  XXXIV.  1.  4. 

Mrs.  C was  seized  every  day  about  the  same  hour  with 

violent  pain  on  the  right  side  of  her  bowels  about  the  situation 
of  the  lower  edge  of  the  liver,  without  fever,  which  increased 
for  an  hour  or  two,  till  it  became  totally  intolerable.  After 
violent  screaming  she  fell  into  convulsions,  which  terminated 
sometimes  in  fainting,  with  or  without  stertor,  as  in  common 
epilepsy;  at  other  times  a temporary  insanity  supervened; 
which  condnued  about  half  an  hour,  and  the  fit  ceased.  These 
paroxysms  had  returned  daily  for  two  or  three  weeks,  and  were 
at  length  removed  by  large  doses  of  opium,  like  the  fits  of  re- 


Giass  III.  1.  1.  8. 


OP  VOLITION. 


287 

verle  or  somnambulation.  About  half  an  hour  before  the  ex,] 
pected  return  of  the  fit  three  or  four  grains  of  opium  were  exhi- 
bited, and  then  tincture  of  opium  was  given  in  warm  brandy  and 
water  about  twenty  or  thirty  drops  every  half  hour,  till  the  eyes 
became  somewhat  inflamed,  and  the  nose  began  to  itch,  and  by 
the  sharp  movements  of  the  patient,  or  quick  speech,  an  evident 
intoxication  appeared;  and  then  it  generally  happened  that  the 
pain  ceased.  But  the  effects  of  this  large  dose  of  opium  was 
succeeded  by  perpetual  sickness  and  efforts  to  vomit,  with  great 
general  debility  all  the  succeeding  day. 

The  rationale  of  this  temporary  cure  from  the  exhibition  of 
opium  and  vinous  spirit  depends  on  the  great  expenditure  of 
sensorial  power  in  the  increased  actions  of  ail  the  irritative  mo- 
tions, by  the  stimulus  of  such  large  quantities  of  opium  and  vinous 
spirit;  together  with  the  production  of  much  sensation,  and 
many  movements  of  the  organs  of  sense  or  ideas  in  consequence 
of  that  sensation;  and  lastly,  even  the  motions  of  the  arterial 
system  become  accelerated  by  this  degree  of  intoxication, 
all  which  soon  exhausted  so  much  sensorial  power  as  to  re- 
lieve the  pain;  which  would  otherwise  have  caused  convulsions 
or  insanity,  which  are  other  means  of  expending  sensorial  power. 
The  general  debility  on  the  succeeding  day,  and  the  particular 
debility  of  the  stomach,  attended  in  consequence  with  sickness 
and  frequent  efforts  to  vomit,  were  occasioned  by  the  system 
having  previously  been  so  strongly  stimulated,  and  those  parts 
in  particular  on  which  the  opium  and  wine  more  immedi- 
ately acted.  This  sickness  continued  so  many  hours  as  to 
break  the  catenation  of  motions,  which  had  daily  reproduced 
the  paroxysm;  and  thus  it  generally  happened,  that  the  whole 
disease  ceased  for  some  weeks  or  months  from  one  great  intoxi- 
cation, a circumstance  not  easily  to  be  explained  on  any  other 
theory. 

The  excess  or  defect  of  motion  in  any  part  of  the  system  oc- 
casions the  production  of  pain  in  that  part,  as  in  Sect.  XII.  1.  6. 
This  defect  or  excess  of  fibrous  action  is  generally  induced  by 
excess  or  defect  of  the  stimulus  of  objects  external  to  the  moving- 
organ.  But  there  is  another  source  of  excessive  fibrous  action, 
and  consequent  pain,  which  is  from  excess  of  volition,  which 
is  liable  to  affect  those  muscles,  that  have  weak  antagonists; 
as  diose  which  support  the  under  jaw,  and  close  the  moulh 
in  biting,  and  those  of  the  calf  of  the  leg;  which  are  thus  liable 
to  fixed  or  painful  contractions,  as  in  trismus,  or  locked  jaw,  and 
in  the  cramp  of  the  calf  of  the  leg;  and  perhaps  in  some  colics, 
as  in  that  of  Japan:  these  pains,  from  contraction  arising  from 
excess  of  volition  in  the  part  from  the  want  of  the  counteraction 


288 


DISEASES 


Class  III.  1.  1.  9. 


of  antagonist  muscles,  may  give  occasional  cause  to  epileptic  fits, 
and  may  be  relieved  in  the  same  way,  either  by  exciting  irrita- 
tive and  sensitive  motions  by  the  stimulus  of  opium  and  wine; 
or  by  convulsions  or  insanity,  as  described  above,  which  are  only 
different  methods  of  exhausting  tire  general  quantity  of  sensorial 
power. 

Considering  the  great  resemblance  between  this  kind  of  pain- 
ful epilepsy  and  the  colic  of  Japan,  as  described  by  Kaempfer: 
and  that  that  disease  was  said  to  be  cured  by  acupuncture,  or  the 
prick  of  a needle;  1 directed  some  very  thin  steel  needles  to  be 
made  about  three  inches  long,  and  of  such  a temper,  that  they 
would  bend  double  rather  than  break;  and  wrapped  wax  thread 
over  about  half  an  inch  of  the  blunt  end  for  a handle.  One  of 
these  needles,  when  the  pain  occurred,  was  pushed  about  an 
inch  into  the  painful  part,  and  the  pain  instantly  ceased;  but  I 
was  not  certain,  whether  the  fear  of  the  patient,  or  the  stimulus 
of  the  puncture,  occasioned  the  cessation  of  pain;  and  as  the 
paroxysm  had  continued  some  weeks,  and  was  then  declining, 
the  experiment  w'as  not  tried  again.  The  disease  is  said  to  be 
very  frequent  in  Japan,  and  its  seat  to  be  in  the  bowels,  and 
that  the  acupuncture  eliminates  the  air,  which  is  supposed  to 
distend  the  bowrel.  But  though  the  aperture  thus  made  is  too 
small  to  admit  of  the  eduction  of  air;  yet  as  the  stimulus  of  so 
small  a puncture  may  either  excite  a torpid  part  into  action,  or 
cause  a spasmodic  one  to  cease  to  act;  and  lastly,  as  no  injury 
could  be  likely  to  ensue  from  so  small  a perforation,  1 should  be 
inclined  at  some  future  time  to  give  this  a fairer  trial  in  similar 
circumstances. 

Another  thing  worth  trial  at  the  commencement  of  this  de- 
plorable disease  would  be  electricity,  by  passing  strong  shocks 
through  the  painful  part;  which,  whether  the  pain  was  owing 
to  the  inaction  of  that  part,  or  of  some  other  membrane  asso- 
ciated with  it,  might  stimulate  them  into  exertion;  or  into  inac- 
tivity, if  owing  to  fixed  painful  contraction. 

And  lastly,  the  cold  bath,  or  aspersions  with  cold  water  on  the 
affected  part,  according  to  the  method  of  Dr.  Currie  in  the  Me- 
moirs of  a Med.  Soc.  London,  Vol.  III.  p.  147,  might  produce 
great  effect  at  the  commencement  of  the  pain.  Nevertheless 
opium  duly  administered,  so  as  to  precede  the  expected  paroxysm, 
and  in  such  doses,  given  by  degrees,  as  to  induce  intoxication, 
is  principally  to  be  depended  upon  in  this  deplorable  malady. 
To  which  should  be  added,  that  if  venesection  can  be  previously 
performed,  even  to  but  few  ounces,  the  effect  of  the  opium  is 
much  more  certain;  and  still  more  so,  if  there  be  time  to  pre- 
mise a brisk  cathartic,  or  even  an  emetic.  The  effect  of  increased 


Ciass  III.  1.  1.  9. 


OF  VOLITION. 


2S9 


stimulus  is  so  much  greater  after  a previous  defect  of  stimulus; 
and  this  is  still  of  greater  advantage,  where  the  cause  of  the  dis- 
ease happens  to  consist  in  a material,  which  can  be  absorbed. 
See  Art.  IV.  2.  8. 

M.  M.  Venesection.  An  emetic.  A cathartic.  Warm  bath. 
Opium  a grain  every  half  hour.  Wine.  Spirit  of  wine.  If  the 
patient  becomes  intoxicated  by  the  above  means,  the  fit  ceases, 
and  violent  vomitings  and  debility  succeed  on  the  subsequent 
day,  and  prevent  a return.  Blisters  or  sinapisms  on  the  small  of 
the  leg,  taken  off  when  they  give  much  pain,  are  of  use  in  slighter 
convulsions.  Acupuncture.  Electricity.  Aspersion  with  cold 
water  on  the  painful  part,  A bag  of  snow  or  ice  applied  on  the 
pained  part. 

9.  Somnambulismus.  Sleep-walking  is  a part  of  reverie,  or 
studium  inane,  described  in  Sect.  XIX.  In  this  malady  the  pa- 
tients have  only  the  general  appearance  of  being  asleep  in  re- 
spect to  their  inattention  to  the  stimulus  of  external  objects,  but, 
like  the  epilepsies  above  described,  it  consists  in  voluntary  exer- 
tions to  relieve  pain.  The  muscles  are  subservient  to  the  will, 
as  appears  by  the  patient’s  walking  about,  and  sometimes  doing 
the  common  offices  of  life.  The  ideas  of  the  mind  also  are  obe- 
dient to  the  will,  because  the  patient’s  discourse  is  consistent, 
though  he  answers  imaginary  questions.  The  irritated  ideas  of 
external  objects  continue  in  this  malady,  because  the  patients  do 
not  run  against  the  furniture  of  the  room;  and  when  they  ap- 
ply their  volition  to  their  organs  of  sense,  they  become  sensible 
of  the  objects  they  attend  to,  but  not  otherwise,  as  general  sen- 
sation is  destroyed  by  the  violence  of  their  voluntary  exertions. 
At  the  same  time  the  sensations  of  pleasure  in  consequence  of 
ideas  excited  by  volition  are  vividly  experienced,  and  other  ideas 
seem  to  be  excited  by  these  pleasurable  sensations,  as  appears  in 
the  case  of  Master  A.  Sect.  XXXIV.  3.  1 . where  a history  of  a 
hunting  scene  was  voluntarily  recalled,  with  all  the  pleasurable 
ideas  which  attended  it.  In  melancholy  madness  the  patient  is 
employed  in  voluntarily  exciting  one  idea,  with  those  which  are 
connected  with  it  by  voluntary  associations  only,  but  not  so  vio- 
lently as  to  exclude  the  stimuli  of  external  objects.  In  reverie 
variety  of  ideas  are  occasionally  excited  by  volition,  and  those 
which  are  connected  with  them  either  by  sensitive  or  voluntary 
associations,  and  that  so  violently  as  to  exclude  the  stimuli  of  ex- 
ternal objects.  These  two  situations  of  our  sensual  motions,  or 
ideas,  resemble  convulsion  and  epilepsy;  as  in  the  former  the 
stimulus  of  external  objects  is  still  perceived,  but  not  in  the  lat- 
ter. Whence  this  disease,  so  far  from  being  connected  with 
sleep,  though  it  has  by  universal  mistake  acquired  its  name  from 

VOL.  It.  p p 


290 


DISEASES 


CtASS  HI.  1. 1.  10. 


it,  arises  from  excess  of  volition,  and  not  from  a suspension  of  it; 
and  though,  like  other  kinds  of  epilepsy,  it  often  attacks  the  pa- 
tients in  their  sleep,  yet  those  two,  whom  I saw,  were  more  fre- 
quently seized  with  it  while  awake,  the  sleep-walking  being  a 
part  of  the  reverie.  See  Sect.  XIX.  and  XXXIV.  3.  and  Class 

II.  1.  7.  4.  and  III.  1.  2.  18. 

M.  M.  Opium  in  large  doses  before  the  expected  paroxysm. 

10.  Asthma  convulsivum.  The  fits  of  convulsive  asthma  return 
at  periods,  and  are  attended  with  cold  extremities,  and  so  far 
resemble  the  access  of  an  intermittent  fever;  but,  as  the  lungs 
are  not  sensible  to  the  pain  of  cold,  a shivering  does  not  suc- 
ceed, but  instead  of  it  violent  efforts  of  respiration;  which  have 
no  tendency,  as  in  the  humoral  asthma,  to  dislodge  any  offend- 
ing material,  but  only  to  relieve  the  pain  by  exertion,  like  the 
shuddering  in  the  beginning  of  ague  fits,  as  explained  Class 

III.  1.  1.  2. 

The  insensibility  of  the  lungs  to  cold  is  observable  on  going 
into  frosty  air  from  a warm  room;  (he  hands  and  face  become 
painfully  cold,  but  no  such  sensation  is  excited  in  the  lungs; 
which  is  another  argument  in  favour  of  the  existence  of  a peculiar 
set  of  nerves  for  the  purpose  of  perceiving  the  universal  fluid 
matter  of  heat,  in  which  all  things  are  immersed.  See  Sect. 
XIV.  6.  Yet  are  the  lungs  nevertheless  very  sensible  to  the  de- 
ficiency of  oxygen  in  the  atmosphere,  as  all  people  experience, 
when  they  go  into  a room  crowded  with  company  and  candles, 
and  complain,  that  it  is  so  close,  they  can  scarcely  breathe;  and 
the  same  in  some  hot  days  in  summer. 

There  are  tw'o  diseases,  which  bear  the  name  of  asthma.  The 
first  is  the  torpor  or  inability  of  the  minute  vessels  of  the  lungs, 
consisting  of  the  terminations  of  the  pulmonary  and  bronchial 
arteries  and  veins,  and  their  attendant  lymphatics;  in  this  cir- 
cumstance it  resembles  the  difficulty  of  breathing,  which  attends 
cold  bathing.  If  this  continues  long,  a congestion  of  fluid  in 
the  air-cells  succeeds,  as  the  absorbent  actions  cease  completely 
before  the  secerning  ones;  as  explained  in  Class  I.  1.2.  3. 
And  the  coldness,  which  attends  the  inaction  of  these  vessels, 
prevents  the  usual  quantity  of  exhalation.  Some  fits  cease  be- 
fore this  congestion  takes  place,  and  in  them  no  violent  sweat- 
ing nor  any  expuition  of  phlegm  occurs.  This  is  the  humoral 
asthma,  described  in  Class  II.  1.  1.7. 

The  second  kind  of  asthma  consists  in  the  convulsive  actions 
in  consequence  of  the  disagreeable  sensations  thus  induced: 
which  in  some  fits  of  asthma  are  very  great,  as  appears  in  the 
violent  efforts  to  raise  the  ribs,  and  to  depress  the  diaphragm, 
by  lifting  the  shoulders.  Tuese,  so  long  as  they  contribute  to 


©i.iss  m.  1. 1. 10. 


OP  VOLITION”. 


291 


remove  the  cause  of  the  disease,  are  not  properly  convulsions, 
but  exertions  immediately  caused  by  sensation;  but  in  this  kind  of 
asthma  they  are  only  efforts  to  relieve  pain,  and  are  frequently 
preceded  by  other  epileptic  convulsions. 

These  tvvo"kinds  of  asthma  have  so  many  resembling  features, 
and  are  so  frequently  intermixed,  that  it  often  requires  great  at- 
tention to  distinguish  them;  but  as  one  of  them  is  allied  to  ana- 
sarca, and  the  other  to  epilepsy,  we  shall  acquire  a clearer  idea 
of  them  by  comparing  them  with  those  disorders.  A criterion 
of  the  humoral  or  hydropic  asthma  is,  that  it  is  relieved  by  copi- 
ous sweats  about  the  head  and  breast,  which  are  to  be  ascribed 
to  the  sensitive  exertions  of  the  pulmonary  vessels  to  relieve  the 
pain  occasioned  by  the  anasarcous  congestion  in  the  air-ceils; 
and  which  is  effected  by  the  increased  absorption  of  the  mucus, 
and  its  elimination  by  the  retrograde  action  of  those  lymphatics 
of  the  skin,  the  branches  of  which  communicate  with  the  pul- 
monary ones;  and  which  partial  sweats  do  not  easily  admit  of 
any  other  explanation.  See  Class  I.  3.  2.  8.  Another  criterion 
of  it  is,  that  it  is  generally  attended  with  swelled  legs,  or  other 
symptoms  of  anasarca.  A criterion  of  the  convulsive  asthma 
may  be  had  from  the  absence  of  these  cold  clammy  sweats  of  the 
upper  part  of  the  body  only,  and  from  the  patient  having  occa- 
sionally been  subject  to  convulsions  of  the  limbs,  as  in  the  com- 
mon epilepsy. 

It  may  thus  frequently  happen,  that  in  the  humoral  asthma 
some  exertions  of  the  lungs  may  occur,  which  may  not  contri- 
bute to  discharge  the  anasarcous  lymph,  but  may  be  efforts  simply 
to  relieve  pain;  besides  those  efforts,  which  produce  the  increased 
absorption  and  elimination  of  it;  and  thus  we  have  a bodily  dis- 
ease resembling  in  this  circumstance  the  reverie,  in  which  both 
sensitive  and  voluntary  motions  are  at  the  same  time,  or  in  suc- 
cession, excited  for  the  purpose  of  relieving  pain. 

It  may  likewise  sometimes  happen,  that  the  disagreeable  sen- 
sation, occasioned  by  the^&ongestion  of  lymph  in  the  air  cells  in 
the  humoral  or  hydropic  asthma,  may  induce  voluntary  convul- 
sions of  the  respiratory  organs  only  to  relieve  the  pain,  without 
any  sensitive  action^  of  the  pulmonary  absorbents  to  absorb  and 
eliminate  the  congestion  of  serous  fluid;  and  thus  the  same 
cause  may  occasionally  induce  either  the  humoral  or  convulsive 
asthma. 

The  humoral  asthma  has  but  one  remote  cause,  which  is  the 
torpor  of  the  pulmonary  vessels,  like  that  which  occurs  on  going 
into  the  cold  bath;  or  the  want  of  absorption  of  the  pulmonary 
lymphatics  to  take  up  the  lymph  effused  into  the  air-ceils. 
Whereas  the  convulsive  asthma,  like  other  convulsions,  or  epi- 


292 


DISEASES 


Class  III.  1.  1.  10 


lepsies,  may  be  occasioned  by  pain  in  almost  any  remote  part  of 
the  system.  But  in  some  of  the  adult  patients  in  this  disease,  as 
in  many  epilepsies,  I have  suspected  the  remote  cause  to  be  a 
pain  of  the  liver,  or  of  the  biliary  ducts. 

The  asthmas,  which  have  been  induced  in  consequence  of  the 
recess  of  eruptions,  especially  of  the  leprous  kind,  countenance 
this  opinion.  One  lady  I knew,  who  for  many  years  laboured 
under  an  asthma,  which  ceased  on  her  being  afflicted  with  pain, 
swelling,  and  distortion  of  some  of  her  large  joints,  which  were 
esteemed  gouty,  but  perhaps  erroneously.  And  a young  man, 
whom  I saw  yesterday,  was  seized  with  asthma  on  the  retroces- 
sion, or  ceasing  of  eruptions  on  his  face. 

The  convulsive  asthma,  as  well  as  the  hydropic,  is  more  lia- 
ble to  return  in  hot  weather;  which  may  be  occasioned  by  the 
less  quantity  of  oxygen  existing  in  a given  quantity  of  warm  air, 
than  of  cold,  which  can  be  taken  into  the  lungs  at  one  inspira- 
tion. They  are  bodi  most  liable  to  occur  after  the  first  sleep, 
which  is  therefore  a general  criterion  of  asthma.  The  cause  of 
this  is  explained  in  Sect.  XVIII.  15.  and  applies  to  both  of  them, 
as  our  sensibility  to  internal  uneasy  sensation  increases  during 
sleep. 

When  children  are  gaining  teeth,  long  before  they  appear, 
the  pain  of  the  gums  often  induces  convulsions.  This  pain  is 
•relieved  in  some  by  sobbing  and  screaming;  but  in  others  a la- 
borious respiration  is  exerted  to  relieve  the  pain;  and  this  con- 
stitutes the  true  asthma  convulsivum.  In  other  children  again 
general  convulsions,  or  epileptic  paroxysms,  are  induced  for  this 
purpose;  which,  like  other  epilepsies,  become  established  by  ha- 
bit, and  recur  before  the  irritation  has  time  to  produce  the  pain- 
ful sensation,  which  originally  caused  them. 

The  asthma  convulsivum  is  also  sometimes  induced  by  worms, 
or  by  acidity  in  the  stomachs  of  children,  and  by  other  painful 
sensations  in  adults;  in  whom  it  is  generally  called  nervous 
asthma,  and  is  often  joined  with  other  epileptic  symptoms. 

This  asthma  is  distinguished  from  the  peripneumony,  and 
from  the  croup,  by  the  presence  of  fever  in  the  two  latter.  It 
is  distinguished  from  the  humoral  asthma,  as  in  that  the  patients 
are  more  liable  to  run  to  the  cold  air  for  relief,  are  more  subject 
to  cold  extremities,  and  experience  the  returns  of  it  more  fre- 
quently after  their  first  sleep.  It  is  distinguished  from  the  hy- 
drops thoracis,  as  that  has  no  intervals,  and  the  patient  sits  con- 
stantly upright,  and  the  breath  is  colder;  and,  where  the  pericar- 
dium is  affected,  the  pulse  is  quick  and  unequal.  See  Hydrops 
Thoracis,  I.  2.  3.  14. 

jVL  M.  Venesection  once.  A cathartic  with  calomel  once 


Ct ASS  III-  1.  1.  11. 


OF  VOLITION. 


293 


Opium.  Asafoetida.  Warm  bath.  If  the  cause  can  be  detect- 
ed, as  in  toothing  or  worms,  it  should  be  removed.  As  this 
species  of  asthma  is  so  liable  to  recur  during  sleep,  like  epileptic 
fits,  as  mentioned  in  Section  XVIII.  15.  there  was  reason  to  be- 
lieve, that  the  respiration  of  an  atmosphere  mixed  with  hydro- 
gen, or  any  other  innocuous  air,  which  might  dilute  the  oxygen, 
wmuld  be  useful  in  preventing  the  paroxysms  by  decreasing  the 
sensibility  of  the  system.  This,  I am  informed  by  Dr.  Beddoes, 
has  been  used  with  decided  success  by  Dr.  Ferriar.  See  Class 
II.  1.  1.  7. 

11.  Asthma  dolorificum.  Angina  pectoris.  The  painful 
asthma  was  first  described  by  Dr.  Heberden  in  the  Transactions 
of  the  College;  its  principal  symptoms  consist  in  a pain  about 
the  middle  of  the  sternum,  or  rather  lower,  on  every  increase  of 
pulmonary  or  muscular  exertion,  as  in  walking  faster  than  usual, 
or  going  quick  up  a hill,  or  even  up  stairs;  with  great  difficulty 
of  breathing,  so  as  to  occasion  the  patient  instantly  to  stop. 
A pain  in  the  arms  about  the  insertion  of  the  tendon  of  the  pec- 
toral muscle  generally  attends,  and  a desire  of  resting  by  hang- 
ing on  a door  or  branch  of  a tree  by  the  arms  is  sometimes  ob- 
served. Which  is  explained  in  Class  I.  2.  3.  14.  and  in  Sect. 
XXIX.  5.  2. 

These  patients  generally  die  suddenly;  and  on  examining  the 
thorax  no  certain  cause,  or  seat,  of  the  disease  has  been  detect- 
ed; some  have  supposed  the  valves  of  the  arteries,  or  of  the 
heart,  were  imperfect;  and  others  that  the  accumulation  of  fat 
about  this  viscus  or  the  lungs  obstructed  their  due  action;  but 
other  observations  do  not  accord  with  these  suppositions. 

Mr.  W , an  elderly  gentleman,  was  seized  with  asthma 

during  the  hot  pari  of  last  summer;  he  always  waked  from  his 
first  sleep  with  difficult  respiration,  and  pain  in  the  middle  of 
bis  sternum,  and  after  about  an  hour  was  enabled  to  sleep  again. 
As  this  had  returned  for  about  a fortnight,  it  appeared  to  me  to 
be  an  asthma  complicated  with  the  disease,  which  Dr.  Heberden 
has  called  angina  pectoris.  It  w'as  treated  by  venesection,  a ca- 
thartic, and  then  by  a grain  of  opium  given  at  going  to  bed,  with 
ether  and  tincture  of  opium  when  the  pain  or  asthma  recurred, 
and  lastly  with  the  bark,  but  was  several  days  before  it  was  per- 
fectly subdued. 

This  led  me  to  conceive,  that  in  this  painful  asthma  the  dia- 
phragm, as  well  as  the  other  muscles  of  respiration,  was  thrown 
into  convulsive  action,  and  that  the  fibres  of  this  muscle  not  hav- 
ing proper  antagonists,  a painful  fixed  spasm  of  it,  like  that  of 
the  muscles  in  the  calf  of  the  leg  in  the  cramp,  might  be  the 
cause  of  death  in  the  angina  pectoris,  which  I have  thence  ar- 


294 


DISEASES 


Class  III.  1.  1 11 


ranged  under  the  name  of  painful  asthma,  and  leave  for  further 
investigation. 

From  the  history  of  the  case  of  the  late  much  lamented  John 
Hunter,  and  from  rhe  appearances  after  death,  the  case  seems  to 
have  been  of  this  kind,  complicated  with  vertigo  and  consequent 
affection  of  the  stomach.  The  remote  cause  seems  to  have  arisen 
from  ossifications  of  the  coronary  arteries,  and  the  immediate 
cause  of  his  death  from  fixed  spasm  of  the  heart.  Other  histo- 
ries and  dissections  are  still  required  to  put  this  matter  out  of 
doubt;  as  it  is  possible,  that  either  a fixed  spasm  of  the  dia- 
phragm, or  of  the  heart,  which  are  both  furnished  with  but 
weak  antagonists,  may  occasion  sudden  death;  and  these  may 
constitute  two  distinct  diseases. 

Four  patients  1 have  now  in  my  recollection,  all  of  whom  I 
believed  to  labour  under  the  angina  pectoris  in  a great  degree: 
which  have  all  recovered,  and  have  continued  well  three  or  four 
years,  by  the  use,  as  I believe,  of  issues  on  the  inside  of  each 
thigh;  which  were  at  first  large  enough  to  contain  two  peas 
each,  and  afterwards  but  one.  They  took  besides  some  slight 
antimonial  medicine  for  a while,  and  were  reduced  to  half  the 
quantity  or  strength  of  their  usual  potation  of  fermented  liquor. 

The  use  of  femoral  issues  in  angina  pectoris  was  first  recom- 
mended by  Dr.  Macbride,  physician  at  Dublin,  Med.  Observ. 
and  Enquir.  Vol.  VI.  And  I was  further  induced  to  make  trial 
of  them,  not  only  because  the  means  which  I had  before  used 
were  inadequate,  but  from  the  ill  effect  I once  observed  upon 
the  lungs,  which  succeeded  the  cure  of  a small  sore  beneath  the 
knee;  and  argued  conversely,  that  issues  in  the  lower  limbs 
might  assist  a difficult  respiration. 

Mrs.  L , about  fifty,  had  a small  sore  place,  about  the  size 

of  half  a pea  on  the  inside  of  the  leg  a little  below  the  knee.  It 
had  discharged  a pellucid  fluid,  which  she  called  a ley-water, 
daily  for  fourteen  years,  with  a great  deal  of  pain;  on  which 
account  she  applied  to  a surgeon,  who,  by  means  of  bandage  and 
a saturnine  application,  soon  healed  the  sore,  unheedful  of  the 
consequences.  In  less  than  two  months  after  this  I saw  her 
■with  great  difficulty  of  breathing,  which  with  universal  anasarca 
soon  destroyed  her. 

The  theory  of  the  double  effect  of  issues,  as  above  related, 
one  in  relieving  by  their  presence  the  asthma  dolorificum,  and 
the  other  in  producing  by  its  cure  an  anasarca  of  the  lungs,  is 
not  easy  to  explain.  Some  similar  effects  from  cutaneous  erup- 
tions and  from  blisters  are  mentioned  in  Class  I.  1.  2.  9.  In 
these  cases  it  seems  probable,  that  the  pain  occasioned  by  issues, 
and  perhaps  the  absorption  of  a small  quantity  of  areated  puru 


Class  III.  1.  1. 12. 


OF  VOLITION. 


295 


lent  matter,  stimulate  the  whole  system  into  greater  energy  of 
action,  and  thus  prevent  the  torpor  which  is  the  beginning  of  so 
many  diseases.  In  confirmation  of  this  effect  of  pain  on  the  sys- 
tem, I remember  the  case  of  a lady  of  an  ingenious  and  active 
mind,  who,  for  many  of  the  latter  years  of  her  life,  was  perpe- 
tually subject  to  great  pains  of  her  head  from  decaying  teeth. 
When  all  her  teeth  were  gone,  she  became  quite  low  spirited, 
and  melancholy  in  the  popular  sense  of  that  word,  and  after  a 
year  or  two  became  universally  dropsical  and  died. 

M.  M.  Issues  in  the  thighs.  Five  grains  of  rhubarb,  and  one 
sixth  of  a grain  of  emetic  tartar  every  night  for  some  months, 
with  or  without  half  a grain  of  opium.  No  stronger  liquor  than 
small  beer  or  wine  diluted  with  twice  its  quantity  of  water. 
Since  I wrote  the  above  I have  seen  two  cases  of  hydrops  tho- 
racis attended  with  pain  in  the  left  arm,  so  as  to  be  mistaken  for 
asthma  dolorificum,  in  which  femoral  issues,  though  applied  early 
in  the  disease,  had  no  effect. 

12.  Stridor  dentium.  The  clattering  of  the  teeth  on  going 
into  cold  water,  or  in  the  beginning  of  ague-fits,  is  an  exertion 
along  with  the  tremblings  of  the  skin  to  relieve  the  pain  of  cold. 
The  teeth  and  skin  being  more  sensible  to  cold  than  the  more  in- 
ternal parts,  and  more  exposed  to  it,  is  the  reason  that  the  muscles 
which  serve  them,  are  thrown  into  exertion  from  the  pain  of  cold 
rather  than  those  of  respiration,  as  in  screaming  from  more  acute 
pain.  Thus  the  poet, 


Put  but  your  toes  into  cold  water. 

Your  correspondent  teeth  will  clatter. 

Prior. 

In  more  acute  pains  the  jaws  are  gnashed  together  with  great 
vehemence,  insomuch  that  sometimes  the  teeth  are  said  to  have 
been  broken  by  the  force.  See  Sect.  XXXIV.  1.  3.  In  these 
cases  something  should  be  offered  to  the  patient  to  bite,  as  a 
towel,  otherwise  they  are  liable  to  tear  their  own  arms,  or  to 
bite  their  attendants,  as  I have  witnessed  in  the  painful  epilepsy. 

13.  Tetanus  trismus.  Cramp.  The  tetanus  consists  of  a fix- 
ed spasm  of  almost  all  the  muscles  of  the  body;  but  the  trismus, 
or  locked  jaw,  is  the  most  frequent  disease  of  this  kind.  It  is 
generally  believed  to  arise  from  sympathy  with  an  injured  ten- 
don. In  one  case  where  it  occurred  in  consequence  of  a broken 
ancle  from  a fall  from  a horse,  it  was  preceded  by  evident  hy- 
drophobia. Amputation  was  advised  but  not  submitted  to; 
two  wounds  w'ere  laid  into  one  with  scissors,  but  the  patient  died 
about  the  seventh  day  from  the  accident.  In  this  case  the 


296 


DISEASES 


Class  III.  1.  1.  14. 


wounded  tendon,  like  the  wounds  from  the  bite  of  a mad  dog,  did 
not  produce  the  hydrophobia,  and  then  the  locked  jaw,  till  seve- 
ral days  after  the  accident. 

I twice  witnessed  the  locked  jaw  from  a pain  beneath  the 
sternum,  about  the  part  where  it  is  complained  of  in  painful 
asrhma,  or  angina  pectoris,  in  the  same  lady  at  some  years  dis- 
tance of  time.  The  last  time  it  had  continued  two  days,  and  she 
wrote  her  mind  or  expressed  herself  by  signs.  On  observing  a 
broken  tooth,  which  made  a small  aperture  into  her  mouth,  I 
rolled  up  five  grains  of  opium  like  a worm  about  an  inch  long, 
and  introducing  it  over  the  broken  tooth,  pushed  it  onward  by 
means  of  a small  crow-quill;  as  it  dissolved  I observed  she  swal- 
lowed her  saliva,  and  in  less  than  half  an  hour  she  opened  her 
mouth  and  conversed  as  usual. 

Men  are  taught  to  be  ashamed  of  screaming  from  pain  in  their 
early  years;  hence  they  are  prone  to  exert  the  muscles  of  the 
jaws  instead,  which  they  have  learnt  to  exert  frequently  and 
violently  from  their  infancy;  whence  the  locked  jaw.  This  and 
the  following  spasm  have  no  alternative  relaxations,  like  the  pre- 
ceding ones;  which  is  perhaps  owing,  first,  to  the  weakness  of 
their  antagonist  muscles,  those  which  elevate  the  jaw  being  very 
strong  for  the  purpose  of  biting  and  masticating  hard  substances, 
and  for  supporting  the  under  jaw,  with  very  weak  antagonist 
muscles;  and  secondly,  to  their  not  giving  sufficient  relief  even 
for  a moment  to  the  pain,  or  its  preceding  irritation,  which  ex- 
cited them. 

M.  M.  Opium  in  very  large  quantities.  Mercurial  oint- 
ment used  extensively.  Electricity,  Cold  bath.  Dilate  the 
wound,  and  fill  it  with  lint  moistened  w'ith  spirit  of  turpen- 
tine; w'hich  inflames  the  wound,  and  cures  or  prevents  the  con- 
vulsions. See  a case,  Transact,  of  American  Society,  Yol.  II 
p.  227. 

Wine  in  large  quantities  in  one  case  was  more  successful  than 
opium;  it  probably  inflames  more,  which  in  this  disease  is  de- 
sirable. Between  two  or  three  ounces  of  bark,  and  from  a quart 
to  three  pints  of  wine  a day,  succeeded  better  than  opium.  Ib. 

14.  Tetanus  dolor  if  cus.  Painful  cramp.  This  kind  of  spasm 
most  frequently  attacks  the  calf  of  the  leg,  or  muscles  of  the 
toes;  it  often  precedes  paroxysms  of  gout,  and  appears  towards 
the  end  of  violent  diarrhoea,  and  from  indigestion,  or  from  acid 
diet.  In  these  cases  it  seems  to  sympathize  with  the  bowels,  but 
is  also  frequently  produced  by  the  pain  of  external  cold,  and  by 
the  too  great  previous  extension  of  the  muscles,  whence  some 
people  get  the  cramp  in  the  extensor  muscles  of  the  toes  after 


Class  III.  1. 1. 15. 


OF  VOLITION. 


29V 


walking  down  hill,  and  of  those  of  the  calf  of  the  leg  after  walk- 
ing up  a steep  eminence.  For  the  reason  why  these  cramps 
commence  in  sleep,  see  Sect.  XVIII.  15. 

The  muscle  in  this  disease  contracts  itself  to  relieve  some 
smaller  pain,  either  from  irritation  or  association,  and  then  falls 
into  great  pain  itself,  from  the  too  great  action  of  its  own  fibres. 
Hence  any  muscle,  by  being  too  vehemently  exerted,  falls  into 
cramp,  as  in  swimming  too  forcibly  in  water,  which  is  painfully 
cold;  and  a secondary  pain  is  then  induced  by  ihe  too  violent 
contraction  of  the  muscle;  though  the  pain,  which  was  the 
cause  of  the  contraction,  ceases.  Which  accounts  for  the  con- 
tinuance of  the  contraction,  and  distinguishes  this  disease  from 
other  convulsions,  which  are  relaxed  and  exerted  alternately. 
Hence  whatever  may  be  the  cause  of  their  primary  pain,  which 
occasions  the  cramp  of  the  calf  of  the  leg,  the  secondary  one  is 
relievable  by  standing  up,  and  thus  by  the  weight  of  the  body 
on  the  toes  forcibly  extending  the  contracted  muscles.  For  the 
cause  which  induces  these  muscles  of  the  calf  of  the  leg  to  fall 
into  more  violent  contraction  than  other  spasmodic  muscles, 
proceeds  from  the  weakness  of  their  antagonist  muscles;  as 
they  are  generally  extended  again  after  action  by  the  weight 
of  the  body  on  the  balls  of  the  toes.  See  the  preceding  article. 

M.  M.  Rub  the  legs  with  camphor  dissolved  in  oii,  and  let 
the  patient  wear  stockings  in  bed.  If  a foot-board  be  put  at 
the  bed’s  feet,  and  the  bed  be  so  inclined,  that  he  will  rest  a 
little  with  his  toes  against  the  foot-board,''  that  pressure  is  said 
to  prevent  the  undue  contractions  of  the  musculi  gastrocnemii, 
which  constitute  the  calf  of  the  leg.  In  gouty  patients,  or 
where  the  bowels  are  affected  with  acidity,  half  a grain  of  opium, 
and  six  grains  of  rhubarb,  and  six  of  chalk,  every  night.  Flesh- 
meat  for  supper.  A little  very  weak  warm  spirit  and  water  may 
be  taken  for  present  relief,  when  these  cramps  are  very  trouble- 
some to  weak  or  gouty  paaents. 

15.  Hydrophobia.  Dread  of  water  generally  attending  ca- 
nine madness.  I was  witness  to  a case,  where  this  disease  pre- 
ceded the  locked  jaw  from  a wound  in  the  ancle,  occasioned  by 
a fall  from  a horse;  as  mentioned  in  the  preceding  article.  It 
came  on  about  the  sixth  day  after  the  accident;  when  the  patient 
attempted  to  swallow  fluids,  he  became  convulsed  all  over  from 
the  pain  of  this  attempt,  and  spurted  them  out  of  his  mouth  with 
violence.  It  is  also  said  to  happen  in  some  hysterical  cases. 
Hence  it  seems  rather  the  immediate  consequence  of  a pained 
tendon,  than  of  a contagious  poison.  And  is  so  far  analogous 
to  tetanus,  according  with  the  opinions  of  Dr.  Rush  and  Dr 
Percival. 

q q 


VOL  II. 


298 


DISEASES 


Class  III.  1.  1.  15. 


In  other  respects,  as  it  is  produced  by  the  saliva  of  an  enraged 
animal  instilled  inio  a wound,  it  would  seem  analogous  to 
the  poison  of  venomous  animals.  And  from  the  manner  of  its  ac- 
cess so  long  after  the  bite,  and  of  its  termination  in  a short  time, 
it  would  seem  to  resemble  the  progress  of  contagious  fevers. 
See  Sect.  XXII.  3.  3. 

If  the  patient  was  bitten  in  a part,  which  could  be  totally  cut 
away,  as  a finger,  even  after  the  hydrophobia  appears,  it  is  pro- 
abie  it  might  cure  it;  as  I suspect  the  cause  still  remains  in  the 
■wounded  tendon,  and  not  in  a diffused  infection  tainting  the  blood. 
Hence  there  are  generally  uneasy  sensations,  as  cold  or  numbness, 
in  the  old  cicatrix,  before  the  hydrophobia  commences.  See  a 
case  in  Medical  Communications,  Vol.  II.  p.  190. 

If  the  diseased  tendon  could  be  inflamed  without  cutting  it  out, 
as  by  cupping,  or  caustic,  or  blister  after  cupping,  and  this  in  the 
old  wound  long  since  healed,  after  the  hydrophobia  commences, 
it  might  prevent  the  spasms  about  the  throat.  As  inflaming  the 
teeth  by  the  use  of  mercury  is  of  use  in  some  kinds  of  hemicrania. 
Pu"  spirit  of  turpentine  on  the  wound,  wash  it  well.  See  Class 
I.  3.  1.  11.  IV.  1.  2.  7. 

M.  M.  Wine,  musk,  oil,  internally.  Opium,  mercurial  oint- 
ment, used  extensively.  Mercurial  fumigation.  Turpeth  mi- 
neral. To  salivate  the  patient  as  soon  as  possible.  Exsection  or 
a caustic  on  the  scar,  even  after  the  appearance  of  hydrophobia. 
Put  a tight  bandage  on  the  limb  above  the  scar  of  the  old  wound 
to  benumb  the  pained  tendon,  however  long  the  wound  may 
have  been  healed.  Could  a hollow  catheter  of  elastic  gum,  ca- 
outchouc, be  introduced  into  the  oesophagus  by  the  mouth  or 
nostril,  and  liquid  nourishment  be  thus  conveyed  into  the  stomach  .1 
See  Desault’s  Journal,  Case  I.  where  in  an  ulcer  of  the  mouth,  such 
a catheter  was  introduced  by  the  nostril,  and  kept  in  the  oeso- 
phagus for  a month,  by  which  means  the  patient  was  nourished 
and  preserved. 

It  is  recommended  by  Dr.  Bardsley  to  give  oil  internally  by  a 
similar  method  contrived  by  Mr.  John  Hunter.  He  covered  a 
probang  with  the  skin  of  a small  eel,  or  the  gut  of  a lamb  or  cat. 
It  was  tied  up  at  one  end  above  and  below  the  sponge,  and  a slit 
made  above  the  upper  ligature;  to  the  other  end  of  the  eel  skin 
or  gut  was  fixed  a bladder  and  pipe.  The  probang  thus  covered 
was  introduced  into  the  stomach,  and  the  liquid  food  or  medicine 
was  put  into  the  bladder  and  squeezed  down  through  the  eel-skin. 
Mem.  of  Society  at  Manchester.  See  Class  I.  2.  3.  25. 

Dr.  Bardsley  has  endeavoured  to  prove,  that  dogs  never  ex- 
perience the  hydrophobia,  or  canine  madness,  without  having 
been  previously  bitten  or  infected;  and  secondly,  that  the  dis- 


Class  HI.  1. 1.  IS. 


OF  VOLITION. 


299 


ease  in  this  species  of  animal  always  shews  itself  in  five  or  sis 
weeks;  and  concludes  from  hence,  that  this  dreadful  malady 
might  be  annihilated  by  making  all  the  dogs  in  Great  Britain 
perform  a kind  of  quarantine,  by  shutting  them  up  for  a certain 
number  of  weeks.  Though  the  disease  from  the  bite  of  the  mad 
dog  is  perhaps  more  analogous  to  those  from  the  wounds  inflicted 
by  venomous  animals  than  to  those  from  other  contagious  matter, 
yet  these  observations  are  well  worthy  further  attention;  which 
the  author  promises. 

In  Dr.  Hamilton’s  elaborate  Treatise  on  Hydrophobia,  Long- 
man, London,  it  is  proposed  to  try  the  effect  of  arsenic  in  this  dis- 
ease, which  is  said  to  be  the  principal  ingredient  of  the  Tanjore 
pill,  which  is  said  to  cure  those  who  are  diseased  by  the  bite  of 
serpents,  and  to  cure  the  hydrophobia. 

A solution  of  sublimate  of  mercury  in  rectified  spirits  is  also 
worthy  a trial,  as  mentioned  in  Class  I.  3.  1.  II. 


300 


DISEA9ES 


Glass  III.  1.  2 


ORDO  I. 

Increased  Volition. 

GENUS  II. 

With  increased  Actions  of  the  Organs  of  Sense. 

In  every  species  of  madness  there  is  a peculiar  idea  either  of 
desire  or  aversion,  which  is  perpetually  excited  in  the  mind  with 
all  its  connections.  In  some  constitutions  this  is  connected  with 
pleasurable  ideas  without  the  exertion  of  much  muscular  action, 
in  others  it  produces  violent  muscular  action  to  gain  or  avoid 
the  object  of  it,  in  others  it  is  attended  with  despair  and  inaction. 
Mania  is  the  general  word  for  the  two  former  of  these,  and  melau- 
cholia  for  the  latter;  but  the  species  of  them  are  as  numerous  as 
the  desires  and  aversions  of  mankind. 

In  the  present  age  the  pleasurable  insanities  are  most  frequent- 
ly induced  by  superstitious  hopes  of  Heaven,  by  sentimental  love, 
and  by  personal  vanity.  The  furious  insanities  by  priue,  anger, 
revenge,  suspicion.  And  the  melancholy  ones  by  fear  of  poverty, 
fear  of  death,  and  fear  of  hell;  with  innumerable  others. 

Q'licqukl  agunt  homines,  votnm,  timor,  ira,  voluptas, 

Gaudia,  discursas,  nostri  est  farrago  libelli. 

Jcvex.  I.  85. 

This  idea,  however,  which  induces  madness  or  melancholy, 
is  generally  untrue;  that  is,  the  object  is  a mistaken  fact.  As 
when  a patient  is  persuaded  he  has  the  itch,  or  venereal  disease,, 
of  which  he  has  no  symptom,  and  becomes  mad  from  the  pain 
this  idea  occasions.  So  that  the  object  of  madness  is  generally 
a delirious  idea,  and  thence  cannot  be  conquered  by  reason;  be- 
cause it  continues  to  be  excited  by  painful  sensation,  which  is  a 
stronger  stimulus  than  volition.  Most  frequently  pain  of  body 
is  the  cause  of  convulsion,  wrhick  is  often  however  exchanged 
for  madness;  and  a painful  delirious  idea  is  most  frequently  the 
cause  of  madness  originally,  but  sometimes  of  convulsion.  Thus 
I have  seen  a young  lady  become  convulsed  from  a fright,  and  die 
in  a few  days;  and  a temporary  madness  frequently  terminates 
the  paroxysms  of  the  epilepsia  dolorifica,  and  an  insanity  of  greater 
permanence  is  frequently  induced  by  the  pains  or  bruises  of 
parturition. 

Where  the  patient  is  debilitated,  a quick  pulse  sometimes  at- 


Class  III.  1.  2. 


OF  VOLITION. 


30 1 


tends  insane  people,  which  is  nevertheless  generally  only  a symp- 
tom of  the  debility  owing  to  the  too  great  expenditure  of  senso- 
rial power;  or  of  the  paucity  of  its  production,  as  an  irritative, 
or  insensitive  in  irritated  fever.  See  Class  III.  1.  1 . 

But  nevertheless  where  the  quick  pulse  is  permanent,  it  shews 
the  presence  of  fever;  and  as  the  madness  then  generally  arises 
from  the  disagreeable  sensations  attending  the  fever,  it  is  so  far 
a good  symptom;  because  when  the  fever  is  cured,  or  ceases 
spontaneously,  the  insanity  most  frequently  vanishes  at  the  same 
time. 

The  stimulus  of  so  much  volition  supports  insane  people  un- 
der variety  of  hardships,  and  contributes  to  the  cure  of  diseases 
from  debility,  as  sometimes  occurs  towards  the  end  of  fevers. 
See  Sect.  XXXIV.  2.  5.  And,  on  the  same  account,  they  bear 
large  doses  of  medicines  to  procure  any  operation  on  them;  as 
emetics,  and  cathartics,  which,  before  they  produce  their  effect 
in  inverting  the  motions  of  the  stomach  in  vomiting,  or  of  the 
absorbents  of  the  bowels  in  purging,  must  first  weaken  the  na- 
tural actions  of  those  organs,  as  shewn  in  Sect.  XXXV.  1.  13. 

From  these  considerations  it  appears,  that  the  indications  of 
cure  must  consist  in  removing  the  cause  of  the  pain,  whether  it 
arises  from  a delirious  idea,  or  from  a real  fact,  or  from  bodily 
disease  ; or  secondly,  if  this  cannot  be  done,  by  relieving  the 
pain  in  consequence  of  such  idea  or  disease.  The  first  is  some- 
times effected  by  presenting  frequently  ia  a day  contrary  ideas 
to  shew  the  fallacy,  or  the  too  great  estimation,  of  the  painful 
ideas.  2dly.  By  change  of  place,  and  thus  presenting  the  sti- 
mulus of  new  objects,  as  a long  journey.  3dly.  By  producing 
forgetfulness  of  the  idea  or  object,  which  causes  their  pain;  by 
removing  all  things  which  recall  it  to  their  minds;  and  avoiding 
all  conversation  on  similar  subjects.  For  I suppose  no  disease 
of  the  mind  is  so  perfectly  cured  by  other  means  as  by  forget- 
fulness. 

Secondly,  the  pain  in  consequence  of  the  ideas  or  bodily  dis- 
eases above  described  is  to  be  removed,  first,  by  evacuations,  as 
venesection,  emetics,  and  cathartics;  and  then  by  large  doses 
of  opium,  or  by  the  vertigo  occasioned  by  a circulating  swing,  or 
by  a sea-voyage,  which,  as  they  affect  the  organs  of  sense  as  well 
as  evacuate  the  stomach,  may  contribute  to  answer  both  indica- 
tions of  cure. 

Where  maniacs  are  outrageous,  there  can  be  no  doubt  but  co- 
ersion  is  necessary;  which  may  be  done  by  means  of  a strait 
waistcoat;  which  disarms  them  without  hurting  them;  and  by 
tieing  a handkerchief  round  their  ankles  to  prevent  their  escape. 
In  others  there  can  be  no  doubt,  but  that,  confinement  retards 


302 


DISEASES 


Class  III  1.  g, 


rather  than  promotes  their  cure;  which  is  forwarded  by  change 
of  ideas  in  consequence  of  change  of  place  anu  of  objects,  as  by 
travelling  or  sailing. 

The  circumstances  which  render  confinement  necessary,  are, 
first,  if  the  lunatic  is  liable  to  injure  others,  winch  must  be  judg- 
ed of  by  the  outrage  he  has  already  committed.  2uly.  Il  he  is 
likely  to  injure  himself ; this  also  must  be  judged  of  by  the  de- 
spondency of  his  mind,  if  such  exists.  3dly.  If  he  cannot  take 
care  of  his  affairs.  Where  none  of  these  circumstances  exist, 
there  should  be  no  confinement.  For  though  the  mistaken  idea 
continues  to  exist,  yet  if  no  actions  are  produced  in  consequence 
of  it,  ihe  patient  cannot  be  called  insane.  He  can  only  be  term- 
ed dilirious.  If  every  one  who  possesses  mistaken  ideas,  or  who 
puts  false  estimates  on  things,  was  liable  to  confinement,  I know 
not  who  of  my  readers  might  not  tremble  at  the  sight  of  a mad 
house! 

The  most  convenient  distribution  of  insanities  will  be  into 
general,  as  mania  mufabilis,  studium  inane,  and  vigilia;  and 
into  partial  insanities.  These  last  again  may  be  subdivided  into 
desires  and  aversions,  many  of  which  are  succeeded  by  pleasur- 
able or  painful  ideas,  by  fury  or  dejection,  according  to  the  de- 
gree of  violence  of  their  exertions.  Hence  the  analogy  between 
the  insanities  of  the  mind,  and  the  convulsions  of  die  muscles 
described  in  the  preceding  genus,  is  curiously  exact.  The  con- 
vulsions without  stupor,  are  either  just  suliicient  to  obliterate  the 
pain,  which  occasions  them;  or  are  succeeded  by  greater  pain, 
as  in  the  convulsio  dolorifica.  So  the  exertions  in  the  mania 
mutabilis  are  either  just  sufficient  to  allay  the  pain  which  occa- 
sions them,  and  the  patient  dwells  comparatively  in  a quiet  state; 
or  those  exertions  excite  painful  ideas,  which  are  succeeded  by 
furious  discourses,  or  outrageous  actions.  The  studium  inane, 
or  reverie,  resembles  epilepsy,  in  which  there  is  no  sensibility  to 
the  stimuli  of  external  objects.  Vigilia,  or  watchfulness,  may 
be  compared  to  the  general  writhing  of  the  body;  which  is  just  a 
sufficient  exertion  to  relieve  the  pain  which  occasions  it.  Ero- 
tomania may  be  compared  to  trismus,  or  other  muscular  fixed 
spasm,  without  much  subsequent  pain;  and  mceror  to  cramp  of 
the  muscles  of  the  leg,  or  other  fixed  spasm  with  subsequent  pain. 
All  these  coincidences  contribute  to  show,  as  explained  in  Sect. 
III.  5.  that  our  ideas  are  motions  of  the  immediate  organs  of  sense 
obeying  the  same  laws  as  our  muscular  motions. 

The  violence  of  action  accompanying  insanity  depends  much 
on  the  education  of  the  person;  those  who  have  been  proudly 
educated  with  unrestrained  passions,  are  liable  to  greater  fury; 


Class  III  1.  2. 


OF  VOLITION. 


SOS 


and  those,  whose  education  has  been  humble,  to  greater  despon- 
dency. Where  the  delirious  idea,  above  described,  produces 
pleasurable  sensations,  as  in  personal  vanity  or  religious  enthu- 
siasm; it  is  almost  a pity  to  snatch  them  from  their  fool’s  para- 
dise, and  reduce  them  again  to  the  common  lot  of  humanity;  lest 
they  should  complain  of  their  cure,  lik.e  the  patient  described  in 
Horace, 

Pol ! me  occidistis,  amici. 

Noil  servastis,  ait,  cui  sic  extorta  vohiptas, 

Et  dempius  per  vim  mentis  gralissimus  error ! 

As  insanities  arise  from  excess  of  action  of  the  sensorial  power 
ef  volition,  this  excess  of  action  may  be  owing  either  to  the  in- 
crease of  motive  or  stimulus,  or  to  an  increased  quantity  or  accu- 
mulation of  that  sensorial  power.  And  hence,  though  the  greatest 
number  of  insanities  originate  from  increased  motive  to  voluntary 
action,  as  to  avoid  pain  or  to  acquire  pleasure;  yet  there  appear 
to  be  some,  which  have  for  their  cause  an  accumulation  of  the 
sensorial  power  of  volition. 

Thus,  those  who  have  been  accustomed  to  perpetual  exer- 
tions of  volition  in  carrying  on  some  extensive  employment  or  pro- 
fession during  the  first  half  of  their  lives,  are  liable  to  become 
melancholy,  and  even  to  destroy  themselves,  if  they  suddenly 
leave  off  their  very  active  and  anxious  exertions,  and  retire  to  a 
situation  without  employment,  of  which  many  instances  have 
occurred.  This  seems  to  originate  from  the  pain  occasioned  by 
the  accumulation  of  the  sensorial  power  of  volition,  which  now 
ceases  to  be  expended  for  want  of  motive.  The  tasdium  vitas  de- 
scribed in  No.  X.  of  this  genus  of  diseases  affects  indolent  people, 
who  possess  accumulated  sensorial  power,  but  want  motive  to  ex- 
cite it  into  such  actions  of  the  muscles  or  ideas,  as  might  in  part 
expend  it. 

The  accumulation  of  sensorial  power  from  the  defect  of  accus- 
tomed actions  seems  to  give  rise  to  some  inordinate  muscular  mo- 
tions, as  the  incessant  jumping  of  a squirrel  confined  in  a cage, 
and  some  of  the  motions  of  children  confined  too  long  in  schools, 
which  are  called  tricks.  See  Class  III.  1.  1.  1.  and  IV.  1.3.2. 
And  I am  inclined  to  think,  that  these  insanities,  which  are  term- 
ed melancholy,  where  no  previous  misfortune  has  occurred,  as  in 
grief  or  disappointed  love,  hut  where  the  patient  sits  perpetually 
brooding  over  some  painful  idea,  which  was  not  previously  ex- 
cited by  any  external  event,  as  in  the  tasdium  vitae,  are  in  general 
occasioned  by  accumulations  of  sensorial  power;  and  the  violent 
insanities  to  increase  of  motive;  that  is,  to  those  pains  or  want  of 
pteasure,  w'hich  excite  aversion  or  desire. 


304 


DISEASES 


Glass  III.  1.  2. 


There  is  finally  reason  to  believe,  that  not  only  sensorial  power 
in  general  is  capable  of  accumulation  in  those  parts  which  h ive 
been  accustomed  to  almost  perpetual  action;  but  also  that  each 
kind  or  species  of  sensorial  power,  as  that  of  irritation,  sensation, 
volition,  and  association,  is  separately  capable  of  accumulation 
in  the  parts  which  have  ajmost  perpetually  been  actuated  by  it; 
which  I hope  some  time  to  consider  more  at  large,  as  ] suspect  it 
may  supply  a key  to  many  of  the  phenomena  noi  only  of  insani- 
ties and  convulsions,  but  to  those  of  fever. 

The  disposition  to  insanity,  as  well  as  to  convulsion,  is  believed 
to  be  hereditary;  and  in  consequence  to  be  induced  in  those 
families  from  slighter  causes  than  in  others.  Convulsions  have 
been  shewn  to  have  been  most  frequently  induced  by  painsowing 
to  defect  of  stimulus,  as  the  shuddering  from  cold,  and  not  from 
pains  from  excess  of  stimulus,  which  are  generaliv  succeeded  by 
inflammation.  But  insanities  are  on  the  contrary  generally  in- 
duced by  pains  from  excess  of  stimulus,  as  from  the  too  violent 
actions  of  our  ideas,  as  in  common  anger,  which  is  an  insanity  of 
short  duration,  for  insanities  generally,  though  not  always,  arise 
from  pains  of  the  organs  of  sense;  but  convulsions  generally, 
though  not  always,  from  pains  of  die  membranes  or  glands.  And 
it  has  been  previously  explained,  that  though  the  membranes  and 
glands,  as  the  stomach  and  skin,  receive  great  pain  from  want  of 
stimulus;  yet  that  the  organs  of  sense,  as  the  eye  and  ear,  r .reive 
no  pain  from  defect  of  stimulus. 

Hence  it  follows,  that  the  constitutions  inos*  liable  to  convul- 
sion, are  those  which  most  reach li  become  torpid  in  some  par:  of 
the  system,  that  is,  which  possess  less  irritability;  and  that  those 
most  liable  to  insanity,  are  such  as  have  exe  ss  of  sensibility; 
and  lastly,  that  these  two  circumstances  generaliv  exist  in  the 
same  constitution:  as  explained  in  Sect.  XXX!.  2.  on  Tempera- 
ments. These  observations  explain  why  epilepsy  and  insanity 
frequently  succeed  or  reciprocate  with  each  other,  and  why  in- 
irritable  habits,  as  scrofulous  ones,  are  liable  to  insanity,  of  which 
I have  known  some  instances. 

In  many  cases  however  there  is  no  appearance  of  the  disposi- 
tion to  epilepsy  or  insanity  of  the  parent  being  transmitted  to  the 
progeny.  First,  where  the  insanity  has  arisen  from  some  violent 
disappointment,  and  not  from  intemperance  in  the  use  ot  spi- 
rituous liquors.  Secondly,  where  the  parent  has  acquired  the 
insanity  or  epilepsy  by  habits  of  intoxication  alter  the  procrea- 
tion of  his  children.  Which  habits  I suppose  to  be  the  general 
cause  of  the  disposition  to  insanity  in  this  country.  See  Class  III. 
1.  1.  7. 

As  the  disposition  to  gout,  dropsy,  epilepsy,  and  insanity,  ap- 


Class  III.  1.  2.  fr 


OF  VOLITION. 


305' 


pears  to  be  produced  by  the  intemperate  use  of  spirituous  po- 
tation, and  is  in  all  of  them  hereditary;  it  seems  probable,  that 
this  disposition  gradually  increases  from  generation  to  generation 
in  those  families  which  continue  for  many  generations  to  be  in- 
temperate in  this  respect;  till  at  length  these  diseases  are  produc- 
ed; that  is,  the  irritability  of  the  system  gradually  is  decreased 
by  this  powerful  stimulus,  and  the  sensibility  at  the  same  time 
increased,  as  explained  in  Sect.  XXXI.  1.  and  2.  This  disposi- 
tion is  communicated  to  the  progeny,  and  becomes  still  increas- 
ed, if  the  same  stimulus  be  continued,  and  so  on  by  a third  and 
fourth  generation;  which  accounts  for  the  appearance  of  epi- 
lepsy in  the  children  of  some  families,  where  it  was  never  known 
before  to  have  existed,  and  could  not  be  ascribed  to  their  own 
intemperance.  A parity  of  reasoning  shews,  that  a few  sober 
generations  may  gradually  in  the  same  manner  restore  a due  de- 
gree of  irritability  to  the  family,  and  decrease  the  excess  of  sensi- 
bility. 

From  hence  it  would  appear  probable,  that  scrofula  and  dropsy 
are  diseases  from  inirritability;  but  that  in  epilepsy  and  in- 
sanity an  excess  of  sensibility  is  added,  and  the  two  faulty  tem- 
peraments are  thus  conjoined. 

SPECIES. 

1.  Mania  mutabilis.  Mutable  madness.  Where  the  patients., 
are  liable  to  mistake  ideas  of  sensation  for  those  from  irritation, 
that  is,  imaginations  for  realities,  if  cured  of  one  source  of  insa- 
nity, they  are  liable  in  a few  months  to  find  another  source  in  some 
new  mistaken  or  imaginary  idea,  and  to  act  from  this  new  idea. 
The  idea  belongs  to  delirium,  when  it  is  an  imaginary  or  mistaken 
one;  but  it  is  the  voluntary  actions  exerted  in  consequence  of 
this  mistaken  idea,  which  constitute  insanity. 

In  this  disease  the  patient  is  liable  carefully  to  conceal  the 
object  of  his  desire  or  aversion.  But  a constant  inordinate  sus- 
picion of  all  people,  and  a carelessness  of  cleanliness,  and  of  de- 
cency, are  generally  concomitants  of  madness.  Their  designs 
cannot  be  counteracted,  till  you  can  investigate  the  delirious  idea 
or  object  of  their  insanity;  but  as  they  are  generally  timid,  they 
are  therefore  less  to  be  dreaded. 

Z.  Z.  called  a young  girl,  one  of  his  maid-servants  into  the 
parlour,  and  with  cocked  pistols  in  his  hands,  ordered  her  to 
strip  herself  naked;  he  then  inspected  her  with  some  attention, 
and  dismissed  her  untouched.  Then  he  stripped  two  of  his 
male  servants  in  the  same  manner,  to  the  great  terror  of  the 
neighbourhood.  After  he  was  secured,  with  much  difficulty  he 

vol.  ii.  r r 


306 


DISEASES 


Class  III.  1.  2.  1. 


was  persuaded  to  tell  me,  that  he  had  got  the  itch,  and  had  ex- 
amined some  of  his  servants  to  find  out  from  whom  he  had  re- 
ceived it;  though  at  the  same  time  there  was  not  a spot  to  be 
seen  on  his  hands,  or  other  parts.  The  outrages  in  consequence 
of  this  false  idea  were  in  some  measure  to  be  ascribed  to  the 
pride  occasioned  by  unrestrained  education,  affluent  wealth,  and 
dignified  family. 

Madness  is  sometimes  produced  by  bodily  pain,  particularly 
I believe  of  a diseased  liver,  like  convulsion  and  epilepsy;  at 
other  times  it  is  caused  by  very  painful  ideas  occasioned  by  ex- 
ternal circumstances,  as  of  grief,  or  disappointment;  but  the 
most  frequent  cause  of  insanity  arises  from  the  pain  of  some 
imaginary  or  mistaken  idea;  which  may  be  termed  hallucinalio 
maniacalis.  This  hallucination  of  one  of  the  senses  is  often 
produced  in  an  instant,  and  generally  becomes  gradually  weak- 
ened in  process  of  time  by  the  perpetual  stimulus  of  external 
objects,  or  by  the  successions  of  other  catenations  of  ideas,  or  by 
tiie  operations  of  medicines;  and  when  the  maniacal  hallucina- 
tion ceases,  or  is  forgotten,  the  violent  exertions  cease,  which 
were  in  consequence  of  it,  and  the  disease  is  cured. 

Mr. , a clergyman,  about  forty  years  of  age,  who  was 

rather  a weak  man,  happened  to  be  drinking  wine  in  jocular 
company,  and  by  accident  swallowed  part  of  the  seal  of  a letter, 
which  he  had  just  then  received;  one  of  his  companions  seeing 
him  alarmed,  cried  out  in  humour,  “ It  will  seal  your  bowels  up.” 
He  became  melancholy  from  that  instant,  and  in  a day  or  two 
refused  to  swallow  any  kind  of  nourishment.  On  being  pressed  to 
give  a reason  for  this  refusal,  he  answered  he  knew  nothing  would 
pass  through  him.  A cathartic  was  given,  which  produced  a 
great  many  evacuations,  but  he  still  persisted,  that  nothing  pass- 
ed through  him;  and  though  he  was  frightened  into  taking  a 
little  broth  once  or  twice  by  threats,  yet  he  soon  ceased  entirely 
to  swallow  any  thing,  and  died  in  consequence  of  this  insane  idea. 

Miss  , a sensible  and  ingenious  lady,  about  thirty,  said 

she  had  seen  an  angel;  who  told  her,  that  she  need  not  eat. 
though  all  others  were  under  the  necessity  of  supporting  their 
earthly  existence  by  food.  After  fruitless  persuasions  to  take 
food,  she  starved  herself  to  death.  It  was  proposed  to  send  an 
angel  of  a higher  order  to  tell  her,  that  now  she  must  begin  to 
eat  and  drink  again;  but  it  was  not  put  into  execution. 

Mrs. , a lady  between  forty  and  fifty  rears  of  age, 

imagined  that  she  heard  a voice  say  to  her  one  day,  as  she  was 
at  her  toilet,  “Repent,  or  you  will  be  damned.”  From  that 
moment  she  became  melancholy,  and  this  hallucination  affected 


OF  VOLITION. 


Class  III.  1.  2.  1. 


3.cn 


her  in  greater  or  less  degree  for  about  two  years;  she  then  re- 
covered perfectly,  and  is  now  a cheerful  old  woman. 

Mrs. , a farmer’s  wife,  going  up  stairs  to  dress,  found 

the  curtains  of  her  bed  drawn,  and  on  undrawing  them,  she  be- 
lieved that  she  saw  the  corpse  of  her  sister,  who  was  then  ill  at 
the  distance  of  twenty  miles,  and  became  from  that  time  insane; 
and  as  her  sister  died  about  that  time,  she  could  not  be  produced 
to  counteract  the  insane  hallucination,  but  she  perfectly  recovered 
in  a few  months. 

Mrs. , a most  elegant,  beautiful,  and  accomplished  lady, 

about  twenty-two  years  of  age,  had  been  married  about  two 
months  to  an  elegant,  polished,  and  affluent  young  man,  and  it 
was  well  known  to  be  a love-match  on  both  sides.  She  sud- 
denly became  melancholy,  and  yet  not  to  so  great  a degree,  but 
that  she  could  command  herself  to  do  the  honours  of  her  table 
with  grace  and  apparent  ease.  After  many  days  entreaty,  she 
at  length  told  me,  that  she  thought  her  marrying  her  husband 
had  made  him  unhappy;  and  that  this  idea  she  could  not  efface 
from  her  mind  day  or  night.  I withstood  her  being  confined, 
as  some  had  advised,  and  proposed  a sea-voyage  to  her,  with  ex- 
pectation that  the  sickness  as  well  as  change  of  objects,  might 
remove  the  insane  hallucination  by  introducing  other  energetic 
ideas;  this  was  not  complied  with,  but  she  travelled  about  Eng- 
land with  her  friends  and  her  husband  for  many  months,  and 
at  length  perfectly  recovered,  and  is  now7 1 am  informed  in  health 
and  spirits. 

These  cases  are  related  to  shew  tire  utility  of  endeavouring  to 
investigate  the  maniacal  idea,  or  hallucination;  as  it  may  not 
only  acquaint  us  with  the  probable  designs  of  the  patient,  from 
whence  may  be  deduced  the  necessity  of  confinement;  but  also 
may  some  time  lead  to  the  most  effectual  plan  of  cure. 

I received  good  information  of  the  truth  of  the  following  case, 
which  was  published  a few  years  ago  in  the  newspapers.  A 
young  farmer  in  Warwickshire,  finding  his  hedges  broke,  and 
the  sticks  carried  away  during  a frosty  season,  determined  to 
watch  for  the  thief.  He  lay  many  cold  hours  under  a hay- 
stack, and  at  length  an  old  woman,  like  a witch  in  a play,  ap- 
proached, and  began  to  pull  up  the  hedge;  he  waited  till  she  had 
tied  up  her  bottle  of  sticks,  and  was  carrying  them  off,  that  he 
might  convict  her  of  the  theft,  and  then  springing  from  his  con- 
cealment, he  seized  his  prey  with  violent  threats.  After  some 
altercation,  in  which  her  load  was  left  upon  the  ground,  she 
kneeled  upon  her  bottle  of  sticks,  and  raising  her  arms  to  Heaven 
beneath  the  bright  moon  then  at  the  full,  spoke  to  the  farmer  al- 
ready shivering  with  cold,  “ Heaven  grant,  that  thou  never  mayest- 


508 


DISEASES 


Class  III.  1.  2.  1. 


know  again  the  blessing  to  be  warm.”  He  complained  of  cold 
all  the  next  day,  and  wore  an  upper  coat,  and  in  a few  days 
another,  and  in  a fortnight  took  to  his  bed,  always  saying  no- 
thing made  him  warm,  he  covered  himself  with  very  many  blank- 
ets, and  had  a sieve  over  his  face,  as  he  lay;  and  from  this  one 
insane  idea  he  kept  his  bed  above  twenty  years  for  fear  of  the 
cold  air,  till  at  length  he  died. 

M.  M.  As  mania  arises  from  pain  either  of  our  muscles  or 
organs  of  sense,  the  arts  of  relieving  pain  must  constitute  the 
method  of  cure.  See  Sect.  XXXIV.  3.  4.  Venesection.  Vo- 
mits of  from  five  grains  to  ten  of  emetic  tartar,  repeated  every 
third  morning  for  three  or  four  times;  with  solution  of  gum  am- 
moniac, and  soluble  tartar,  so  as  to  purge  gently  every  day.  Af- 
terwards warm  bath  for  two  or  three  hours  a day.  Opium  in 
large  doses.  Bark.  Steel. 

Dr.  Binns  gave  two  scruples  (40  grains)  of  solid  opium  at  a 
dose,  and  twenty  grains  four  hours  afterwards;  which  restored 
the  patient.  Dr.  Brandreth  gave  400  drops  of  laudanum  to  a 
maniac  in  the  greatest  possible  furor,  and  in  a few  hours  he  be- 
came calm  and  rational.  Med.  Comment,  for  1791,  p.  384. 

Prognostic. 

The  temporary  quick  pulse  attending  some  maniacal  cases  is 
simply  a symptom  of  debility,  and  is  the  consequence  of  too 
great  exertions;  but  a permanent  quick  pulse  shews  the  pre- 
sence of  fever,  and  is  frequently  a salutary  sign;  because,  if  the 
life  of  the  patient  be  safe,  when  the  fever  ceases,  the  insanity 
generally  vanishes  along  with  it,  as  mentioned  above.  In  this 
case  the  kind  of  fever  must  direct  the  method  of  curing  the  in- 
sanity; which  must  consist  of  moderate  evacuations  and  diluents, 
if  the  pulse  be  strong;  or  of  nutrientia,  bark,  and  small  doses  of 
opium,  if  the  pulse  be  weak. 

Where  the  cause  is  of  a temporary  nature,  as  in  puerperal 
insanity,  there  is  reason  to  hope,  that  the  disease  will  cease, 
when  the  bruises,  or  other  painful  sensations  attending  this  state, 
are  removed.  In  these  cases  the  child  should  be  brought  fre- 
quently to  the  mother,  and  applied  to  her  breast,  if  she  will  suf- 
fer it,  and  this  whether  she  first  attends  to  it  or  not;  as  by  a few 
trials  it  frequently  excites  the  storge,  or  maternal  affection,  and 
removes  the  insanity,  as  I have  witnessed. 

When  the  madness  is  occasioned  by  pain  of  the  teeth,  which 
I believe  is  no  uncommon  case,  these  must  be  extracted;  and 
the  cure  follows  the  extinction  of  the  pain.  There  is  however 
some  difficulty  in  detecting  the  delinquent  tooth  iu  this  case,  as 


Class  HI.  1.  2.  % 


OF  VOLITION. 


309 


in  hemicrania,  unless  by  its  apparent  decay,  or  by  some  previous 
information  of  its  pain  having  been  complained  of;  because  the 
pain  of  the  tooth  ceases,  as  soon  as  the  exertions  of  insanity  com- 
mence. In  this  case  salivation  might  be  tried. 

When  a person  becomes  insane,  who  has  a family  of  small  chil- 
dren to  solicit  his  attention,  the  prognostic  is  very  unfavourable; 
as  it  shews  the  maniacal  hallucination  to  be  more  powerful  than 
those  ideas  which  generally  interest  us  the  most. 

When  an  insane  young  man  shews  no  lascivious  idea,  when 
an  opportunity  of  gratifying  the  passion  of  love  is  presented  to 
him,  as  in  the  case  above  mentioned  of  Z.  Z.  or  when  an  in- 
sane young  lady  shews  no  symptom  of  attachment,  when  address- 
ed honourably  by  a proper  lover,  the  prognostic  is  unfavourable, 
as  it  shews  the  maniacal  hallucination  to  affect  the  mind  stronger 
than  the  natural  passion  of  love,  which  in  civilized  society  is 
strengthened  by  restraint. 

Paralytic  affections  are  said  by  Mr.  Haslam,  to  be  frequently 
succeeded  by  insanity,  and  that  in  these  cases  the  inactivity  of 
some  paralytic  muscles  about  the  face  or  limbs  with  defective 
memory  continue  along  with  the  insanity;  and  he  adds  that  these 
patients  are  seldom  relieved.  Observations  on  Insanity  by  J. 
Haslam,  8vo.  Rivington.  It  was  before  observed,  that  when 
some  limbs  become  paralytic,  as  in  the  common  hemiplegia, 
that  the  other  limbs  are  liable  to  be  for  some  time  in  almost  per- 
petual action,  owing  to  the  superfluity  of  volition,  which  was 
previously  expended  by  the  action  of  those  muscles,  which  are 
now  rendered  disobedient  to  the  sensorial  power  of  volition, 
though  they  may  continue  to  be  excitable  by  irritation  or  sensa- 
tion, as  in  the  act  of  pandiculation,  or  by  electric  shocks.  Now 
if  this  superfluity  of  voluntary  activity  be  exerted  on  the  organs 
of  sense,  delirious  hallucinations  and  insane  actions  are  the  con- 
sequence; and  as  the  power  of  life  is  already  injured  in  a part 
of  the  system,  they  are  less  liable  to  recover,  and  die  like  other 
paralytic  patients.  And  thus  the  insanities  in  consequence  of 
paralytic  affections,  as  well  as  those  in  consequence  of  pain- 
ful sensations  or  ideas,  countenance  the  theory,  that  they 
arise  from  the  excessive  activity  of  the  sensorial  power  of  voli- 
tion. 

2.  Studium  inane.  Reverie  consists  of  violent  voluntary  exer- 
tions of  ideas  to  relieve  pain,  with  all  the  trains  or  tribes  con- 
nected with  them  by  sensations  or  associations.  It  frequently 
alternates  with  epileptic  convulsions;  with  which  it  corresponds, 
in  respect  to  the  insensibility  of  the  mind  to  the  stimuli  of  ex- 
ternal objects,  in  the  same  manner  as  madness  corresponds  with 


310 


DISEASE^ 


Class  III.  1.  2.  2. 


common  convulsion,  in  the  patient’s  possessing  at  the  same  time 
a sensibility  of  the  stimuli  of  external  objects. 

Some  have  been  reported  to  have  been  involved  in  reverie  so 
perfectly,  as  not  to  have  been  disturbed  by  the  discharge  of  a 
cannon;  and  others  to  have  been  insensible  to  torture,  as  the 
martyrs  for  religious  opinions;  but  these  seem  more  properly 
to  belong  to  particular  insanities  than  to  reverie,  like  nostalgia 
and  erotomania. 

Reverie  is  distinguished  from  madness  as  described  above; 
and  from  delirium,  because  the  trains  of  ideas  are  kept  consist- 
ent by  the  power  of  volition,  as  the  person  reasons  and  delibe- 
rates in  it.  Somnambulismus  is  a part  of  reverie,  somnambu- 
lism consisting  in  the  exertions  of  the  locomotive  muscles,  and 
reverie  in  the  exertions  of  the  organs  of  sense;  See  Class  I.  1. 
1.  9.  and  Sect.  XIX.  both  which  are  mixed,  or  alternate  with 
each  other  for  the  purpose  of  relieving  pain. 

When  the  patients  in  reverie  exert  their  volition  on  their  or- 
gans of  sense,  they  can  occasionally  perceive  the  stimuli  of  ex- 
ternal objects,  as  explained  in  Sect.  XIX.  And  in  this  case  it 
resembles  sometimes  an  hallucination  of  the  senses,  as  there  is  a 
mixture  of  fact  and  imagination  in  their  discourse;  but  rnay  be 
thus  distinguished:  hallucinations  of  the  senses  are  allied  to  de- 
lirium, and  are  attended  generally  with  quick  pulse,  and  other 
symptoms  of  great  debility:  but  reverie  is  without  fever,  and 
generally  alternates  with  convulsions;  and  so  much  intuitive 
analogy  (see  Sect.  XVII.  3.  7.)  is  retained  in  its  paroxysms,  as  to 
preserve  a consistency  in  the  trains  of  ideas. 

Miss  G , whose  case  is  related  in  Sect.  III.  5.  S.  said  as 

I once  sat  by  her,  “ My  head  is  fallen  off,  see  it  is  rolled  to  that 
corner  of  the  room,  and  the  little  black  dog  is  nibbling  the  nose 
off.”  On  my  walking  to  the  place  which  she  looked  at,  and 
returning,  and  assuring  her  that  her  nose  was  unhurt,  she  be- 
came pacified,  though  I was  doubtful  whether  she  attended  to 
me.  See  Class  III.  I.  1.  9.  and  Class  III.  1.  2.  2. 

M.  M.  Large  doses  of  opium  given  before  the  expected  pa- 
roxysm, as  in  epilepsia  dolorifica,  Class  III.  1.  1.  S. 

The  hallucinatio  studiosa,  or  false  ideas  in  reverie,  differ 
from  maniacal  hallucinations  above  described,  as  no  insane  ex- 
ertions succeed,  and  in  the  patieuts  whom  I have  seen  they 
have  always  been  totally  forgotten,  when  the  paroxysm  was 
over. 

Master , a school-bov  about  twelve  years  old,  after  he 

came  out  of  a convulsion  "fit  and  sat  up  in  bed,  said  to  me, 
“ Dont  you  see  my  father  standing  at  the  feet  of  the  bed,  he  is 
come  a long  way  on  foot  to  see  me.”  I answered,  no:  “ M hat 


SiASS  III.  1.  1.3. 


OF  VOLITION. 


311 


colour  is  his  coat?”  He  replied,  “A  drab  colour.”  “And 
what  buttons?”  “ Metal  ones,”  he  answered,  and  added,  “ how 
sadly  his  legs  are  swelled.”  In  a few  minutes  he  said,  with  ap- 
parent surprise,  “ He  is  gone,”  and  returned  to  his  perfect  mind. 
Other  cases  are  related  in  Sect.  XIX.  and  XXXIV.  3.  and  in 
Class  III.  1.  2.  2.  with  further  observations  on  this  kind  of  hal- 
lucination; which  however  is  not  the  cause  of  reverie,  but  con- 
stitutes a part  of  it,  the  cause  being  generally  some  uneasy  sensa- 
tion of  the  body. 

3.  Vigilia.  Watchfulness  consists  in  the  unceasing  exertion 
of  volition;  which  is  generally  caused  by  some  degree  of  pain 
either  of  mind  or  of  body,  or  from  defect  of  the  usual  quantity  of 
pleasurable  sensation;  hence  if  those  who  are  accustomed  to 
wine  at  night,  take  tea  instead,  they  cannot  sleep.  The  same 
happens  from  want  of  solid  food  for  supper,  to  those  who  are  ac- 
customed to  use  it;  as  in  these  cases  there  is  pain  or  defect  of 
pleasure  in  the  stomach. 

Sometimes  the  anxiety  about  sleeping,  that  is,  the  desire  to 
sleep,  prevents  sleep;  which  consists  in  an  abolition  of  desire  or 
will.  This  may  so  far  be  compared  to  the  impediment  of  speech 
described  in  Sect.  XVII.  1.  10.  as  the  interference  of  the  will 
prevents  the  effect  desired. 

Another  source  of  watchfulness  may  be  from  the  too  great  se- 
cretion of  sensorial  power  in  the  brain,  as  in  phrenzy,  and  as 
sometimes  happens  from  the  exhibition  of  opium,  and  of  wine; 
if  the  exhaustion  of  sensorial  power  by  the  general  actions  of  the 
system  occasioned  by  the  stimulus  of  these  drugs  can  be  supposed 
to  be  less  than  the  increased  secretion  of  it. 

M.  M.  1.  Solid  food  to  supper.  Wine.  Opium.  Warm 
bath.  2.  The  patient  should  be  told  that  his  want  of  sleep  is  of 
no  consequence  to  his  health.  3.  Venesection  by  cupping.  Ab- 
stinence from  wine.  4.  A blister  by  stimulating  the  skin,  and 
rhubarb  by  stimulating  the  bowels,  will  sometimes  induce  sleep. 
Exercise.  An  uniform  sound,  as  of  a pausing  drop  of  water, 
or  the  murmur  of  bees.  Other  means  are  described  in  Sect, 
XVIII.  20. 

4.  Erotomania.  Sentimental  love.  Described  in  its  excess 
by  romance  writers  and  poets.  As  the  object  of  love  is  beauty, 
and  as  our  perception  of  beauty  consists  in  a recognition  by  the 
sense  of  vision  of  those  objects,  which  have  before  inspired  our 
love,  by  the  pleasure  they  have  afforded  to  many  of  our  senses 
(Sect.  XVI.  6.);  and  as  brute  animals  have  less  accuracy  of 
their  sense  of  vision  than  mankind  (ib. ) ; we  see  the  reason  why 
this  kind  of  love  is  not  frequently  observable  in  the  brute  crea- 
tion, except  perhaps  in  some  married  birds,  or  in  the  affection  of 


312 


DISEASES 


Class  III.  1.  2.  3. 

the  mother  to  her  offspring.  Men  who  have  not  had  leisure  to 
cultivate  their  taste  for  visible  objects,  and  who  have  not  read  the 
works  of  poets  and  romance  writers,  are  less  liable  to  sentiment- 
al love;  and  as  ladies  are  educated  rather  with  an  idea  of  being 
chosen,  than  of  choosing;  there  are  many  men  and  more  women, 
who  have  not  much  of  this  insanity;  and  are  therefore  more 
easily  induced  to  marry  for  convenience  or  interest,  or  from  the 
flattery  of  one  sex  to  the  other. 

In  its  fortunate  gratilication  sentimental  love  is  supposed  to 
supply  the  purest  source  of  human  felicity;  and  from  the  sudden- 
ness with  which  many  of  those  patients,  described  in  species 
I.  of  this  genus,  were  seized  with  the  maniacal  hallucination, 
there  is  reason  to  believe,  that  the  most  violent  sentimental  love 
may  be  acquired  in  a moment  of  time,  as  represented  by  Shak- 
speare  in  the  beginning  of  his  Romeo  and  Juliet,  as  originally 
written. 

Some  have  endeavoured  to  make  a distinction  between  beauty 
and  grace,  and  have  made  them  as  it  were  rivals  for  the  pos- 
session of  the  human  heart;  but  grace  may  be  defined  beauty  in 
action;  for  a sleeping  beauty  cannot  be  called  graceful  in  what- 
ever attitude  she  may  recline;  the  muscles  must  be  in  action  to 
produce  a graceful  attitude,  and  the  limbs  to  produce  a graceful 
motion.  But  though  the  object  of  love  is  beauty,  yet  the  idea  is 
nevertheless  much  enhanced  by  the  imagination  of  the  lover; 
which  appears  from  this  curious  circumstance,  that  the  lady  of 
his  passion  seldom  appears  so  beautiful  to  the  lover  after  a few 
months  separation,  as  his  ideas  had  painted  her  in  his  absence; 
and  there  is  on  that  account,  always  a little  disappointment  felt 
for  a minute  at  their  next  interview  from  this  hallucination  of 
his  ideas. 

This  passion  of  love  produces  reverie  in  its  first  state,  which 
exertion  alleviates  the  pain  of  it,  and  by  the  assistance  of  hope 
converts  it  into  pleasure.  Then  the  lover  seeks  solitude,  lest 
this  agreeable  reverie  should  be  interrupted  by  external  stimuli, 
as  described  by  Virgil. 

Tantum  inter  densas,  umbrosacacumina,  fagos 
Assidue  veniebat,  ibi  Iicec  incondita  solus 
• jVIontibus  et  sylvis  studio  jactubat  inani. 

When  the  pain  of  love  is  so  great  as  not  to  be  relieved  by  the 
exertions  of  reverie,  as  above  described;  as  when  it  is  misplaced 
on  an  object,  of  which  the  lover  cannot  possess  himself;  it  may 
still  be  counteracted  or  conquered  by  the  stoic  philosophy,  which 
strips  all  things  of  their  ornaments,  and  inculcates  “ nil  admira- 
ri.”  Of  which  lessons  may  be  found  in  the  meditations  of  Mar- 


Class  HI.  1.  2.  4. 


OF  VOLITION. 


313 


cus  Antoninus.  The  maniacal  idea  is  said  in  some  lovers  to  have 
been  weakened  by  the  action  of  other  very  energetic  ideas;  such 
as  have  been  occasioned  by  the  death  of  his  favourite  child,  or  by 
the  burning  of  his  house,  or  by  his  being  shipwrecked.  In  those 
cases  the  violence  of  the  new  idea  for  a while  expends  so  much 
sensorial  power  as  to  prevent  the  exertion  of  the  maniacal  one; 
and  new  catenations  succeed.  On  this  theory  the  lover’s  leap, 
so  celebrated  by  poets,  might  affect  a cure,  if  the  patient  escaped 
with  life. 

The  third  stage  of  this  disease  I suppose  is  irremediable;  when 
a lover  has  previously  been  much  encouraged,  and  at  length 
meets  with  neglect  or  disdain;  the  maniacal  idea  is  so  painful 
as  not  to  be  for  a moment  relievable  by  the  exertions  of  reverie, 
but  is  instantly  followed  by  furious  or  melancholy  insanity;  and 
suicide,  or  revenge,  have  frequently  been  the  consequence.  As 
was  lately  exemplified  in  Mr.  Hackman,  who  shot  Miss  Ray  in 
the  lobby  of  the  playhouse.  So  the  poet  describes  the  passion  of 
Dido, 


Moriamur  inultae  ? — 

At  moriamur,  ait, — sic,  sic,  juvat  ire  sub  umbras! 


The  story  of  Medasa  seems  to  have  been  contrived  by  Ovid, 
who  was  a good  judge  of  the  subject,  to  represent  the  savage 
madness  occasioned  by  ill-requited  love.  Thus  the  poet, 

Earth  has  no  rage  like  love  to  hatred  turn’d, 

Nor  Hell  a fury  like  a woman  scorn’d. 

Drtdejt. 

Hence  it  appears  that  though  sentimental  love  does  not  so 
frequently  arise  spontaneously  in  female  bosoms,  yet  that  it  is 
liable  to  become  as  violent,  when  it  has  been  excited  by  the 
courtship  of  the  other  sex,  and  though,  when  it  is  rejected,  after 
courtship  has  produced  it,  it  is  not  always  succeeded  by  such  vi- 
olent effects  as  those  above  mentioned;  which  may  be  ascribed 
to  the  greater  modesty  and  reserve  of  their  education;  yet  the 
disappointed  passion  is  liable  to  prey  upon  their  minds  even  to 
the  hazard  of  their  lives,  of  which  I have  witnessed  two  in- 
stances, in  both  which  the  effects  approached  to  that  occasioned 
by  great  grief.  See  Moeror,  Class  III.  1.  2.  10. 

One  of  these  ladies,  about  30  years  of  age,  was  deserted  by  an 
Irish  gentleman,  who  was  soon  to  have  married  her;  she  was 
seized  suddenly  with  a stupor,  which,  by  those  who  were  not 
acquainted  with  the  cause,  was  mistaken  for  a kind  of  apoplexy; 
she  gradually  recovered  so  as  to  apply  to  her  usual  habits  of  life, 
vol.  ir.  s s 


314 


DISEASES 


Class  III.  1.  2.  5. 


and  in  four  brfive  years  regained  her  cheerfulness,  and  married 
anodier  man.  The  other  was  affected  with  long  stupor,  loss  of 
digestion,  and  total  inability  of  mind  and  body,  which  continued 
a year  or  two,  and  from  which  she  also  gradually  recovered. 

5.  Jhnor  sui.  Vanity  consists  of  an  agreeable  reverie,  and  is 
well  ridiculed  in  the  story  of  Narcissus,  who  so  long  contemplated 
his  own  beautiful  image  in  the  water,  that  he  died  from  neglect  of 
taking  sustenance.  I once  saw  a handsome  young  man,  who  had 
been  so  much  flattered  by  his  parents,  that  his  vanity  rose  so  near 
to  insanity,  that  one  might  discern  by  his  perpetual  attention  to 
himself,  and  the  difficulty  with  which  he  arranged  his  conversa- 
tion, that  the  idea  of  himself  intruded  itself  at  every  comma  or 
pause  of  his  discourse.  In  this  degree  vanity  must  afford  great 
pleasure  to  the  possessor;  and  when  it  exists  within  moderate 
bounds,  may  contribute  much  to  the  happiness  of  social  life. 

My  friend  Mr. , once  complained  to  me,  that  he  was  much 

troubled  with  bashfulness  in  company,  and  believed  that  it  arose 
from  his  want  of  personal  vanity;  on  this  account  he  determined 
on  a journey  to  Paris,  when  Paris  was  the  centre  of  politeness; 
he  there  learnt  to  dress,  to  dance,  and  to  move  his  hands  grace- 
fully in  conversation;  and  returned  a most  consummate  coxcomb. 
But  after  a very  few  years  he  relapsed  into  rusticity  of  dress  and 
manners. 

M.  M.  The  cure  of  vanity  may  he  attempted  by  excess  of 
flat  ery,  which  will  at  length  appear  ridiculous,  or  by  its  famili- 
arity will  cease  to  be  desired.  I remember  to  have  heard  a story 
of  a nobleman  in  the  court  of  France,  when  France  had  a court, 
who  was  so  disagreeably  vain  in  conversation,  that  the  king  was 
pleased  to  direct  his  cure,  which  was  thus  performed.  Two 
gentlemen  were  directed  always  to  attend  him,  one  was  to  stand 
behind  his  chair,  and  the  other  at  a respectful  distance  before 
him;  whenever  his  lordship  began  to  speak,  one  of  them  always 
pronounced,  “Lord  Gallimaufre  is  going  to  say  the  best  thing  in 
the  world.”  And,  as  soon  as  his  lordship  had  done  speaking, 
the  other  attendant  pronounced,  “ Lord  Gallimaufre  has  spoken 
the  best  thing  in  the  world.”  Till  in  a few  weeks  this  noble 
lord  was  so  disgusted  with  praise,  that  he  ceased  to  be  vain;  and 
his  majesty  dismissed  his  keepers. 

6.  Nostalgia.  Maladie  de  Pais.  Calenture.  An  uncon- 
querable desire  of  returning  to  one’s  native  country,  frequent  in 
long  voyages,  in  which  the  patients  become  so  insane  as  to  throw 
themselves  into  the  sea,  mistaking  it  for  green  fields  or  meadows. 
The  Swiss  are  said  to  be  particularly  liable  to  this  disease,  and 


C lass  III.  1. 2.  7. 


OF  VOLITION. 


315 


when  taken  into  foreign  service  frequently  to  desert  from  this 
cause,  and  especially  after  hearing  or  singing  a particular  tune, 
which  was  used  in  their  village  dances,  in  their  native  country, 
on  which  account  the  playing  or  singing  this  tune  was  forbid  by 
the  punishment  of  death.  Zwingerus. 

Dear  is  that  shed  to  which  his  soul  conforms. 

And  dear  that  hill,  which  lifts  him  to  the  storms. 

Goldsmith. 

7.  Spes  religiosci.  Superstitious  hope.  This  maniacal  hallu- 
cination in  its  milder  state  produces,  like  sentimental  love,  an 
agreeable  reverie;  but  when  joined  with  works  of  supereroga- 
tion, it  has  occasioned  many  enormities.  In  India  devotees  con- 
sign themselves  by  vows  to  most  painful  and  unceasing  tortures, 
such  as  holding  up  their  hands,  till  they  cannot  retract  them; 
hanging  up  by  hooks  put  into  the  thick  skin  over  their  shoulders, 
sitting  upon  sharp  points,  and  other  self  torments.  While  in 
our  part  of  the  globe,  fasting  and  mortification,  as  flagellation, 
has  been  believed  to  please  a merciful  Deity!  The  serenity  with 
which  many  have  suffered  cruel  martyrdoms,  is  to  be  ascribed 
to  this  powerful  reverie. 

Mr.  , a clergyman,  formerly  of  this  neighbourhood,  be- 

gan to  bruise  and  wound  himself  for  the  sake  of  religious  morti- 
fication, and  passed  much  time  in  prayer,  and  continued  whole 
nights  alone  in  the  church.  As  he  had  a wife  and  family  of  small 
children,  I believed  the  case  to  be  incurable;  as  otherwise  the 
affection  and  employment  in  his  family  connections  would  have 
opposed  the  beginning  of  this  insanity.  He  was  taken  to  a mad- 
house without  effect;  and  after  he  returned  home,  continued  to 
beat  and  bruise  himself,  and  by  this  kind  of  mortification,  and 
by  sometimes  long  fasting,  he  at  length  became  emaciated  and 
died.  I once  told  him  in  conversation,  that,  “ God  was  a merci- 
ful being,  and  could  not  delight  in  cruelty;  but  that  I supposed 
he  worshipped  the  devil. ” He  was  struck  with  this  idea,  and 
promised  me  not  to  beat  himselffor  three  days,  and  I believe  kept 
his  word  for  one  day.  If  this  idea  had  been  frequently  forced 
on  his  mind,  it  might  probably  have  been  of  service. 

When  these  works  of  supererogation  have  been  of  a public 
nature,  what  cruelties,  murders,  massacres,  has  not  this  insanity 
introduced  into  the  world! — A commander,  who  had  been  very 
active  in  leading  and  encouraging  the  bloody  deeds  of  St.  Bar- 
tholomew’s day  at  Paris,  on  confessing  his  sins  to  a worthy  ec- 
clesiastic on  his  death-bed,  was  asked,  “ Have  you  nothing  to 
say  about  St.  Bartholomew?”  On  that  day,”  he  replied,  “ God 


31t> 


DISEASES 


Class  111.  1.  2.  8. 


Almighty  was  obliged  to  me!” — The  fear  of  Hell  is  another 
insanity,  which  will  be  spoken  of  below. 

8.  Superbia  slemmatis.  Pride  of  family  has  frequently  form- 
ed a maniacal  hallucination,  which  in  its  mild  stale  has  consisted 
in  agreeable  reverie,  but  when  it  has  been  so  painful  as  to  de- 
mand homage  from  others,  it  has  frequently  induced  insane  ex- 
ertions. This  insanity  seems  to  have  existed  in  the  flouiishing 
state  of  Rome,  as  now  all  over  Germany,  and  is  attacked  b\  Ju- 
venal with  great  severity,  a small  part  of  which  I shall  here  give 
as  a method  of  cure.  Sat.  8. 

Say,  what  avails  the  pedigree,  that  brings 
Thy  boasted  line  from  heroes  or  from  kings  ; 

Though  many  a mighty  lord,  in  parchment  roll’d, 

Name  after  name,  thy  coxcomb  hands  unfold  ; 

Though  wreathed  patriots  crowd  thy  marble  halls. 

Or  steel-clad  warriors  frown  along  the  walls ; 

While  on  broad  canvass  in  the  gilded  frame 
Al!  virtues  flourish,  and  all  glories  flame  ? 

Say, — if  ere  noon  with  idiot  laugh  you  lie 
Wallowing  in  wine,  or  cog  the  dubious  die. 

Or  act  unshamed,  by  each  indignant  bust. 

The  midnight  orgies  of  promiscuous  lust! 

Go,  lead  mankind  to- Virtue’s  holy  shrine, 

With  morals  mend  them,  and  with  arts  refine. 

Or  lift,  with  golden  characters  unfurl’d. 

The  Hag  of  peace,  and  save  a warring  world! — 

— So  shall  with  pious  hands  immortal  Fame 
Wreath  all  her  laurels  round  thy  honour'd  name, 

High  o’er  thy  tomb  with  chis$el  bold  engrave, 

“The  tbdii  noble  axe  the  good  and  brave.” 

9.  Jlmbitio.  Inordinate  desire  of  fame.  A carelessness  about 
the  opinions  of  others  is  said  by  Xenophon  to  be  the  source  of  im- 
pudence; certainly  a proper  regard  for  what  others  think  of  us 
frequently  incites  us  to  virtuous  actions,  and  deters  us  from  vici- 
ous ones;  and  increases  our  happiness  by  enlarging  our  sphere 
of  sympathy,  and  by  flattering  our  vanity. 

Abstract  what  others  feel,  what  others  think. 

All  pleasures  sicken,  and  all  glories  sink. 

Pope. 

When  this  reverie  of  ambition  excites  to  conquer  nations,  or 
to  enslave  them,  it  has  been  the  source  of  innumerable  wars,  and 
the  occasion  of  a great  devastation  of  mankind.  Cassar  is  re- 
ported to  have  boasted,  that  he  had  destroyed  three  millions  of 
his  enemies,  and  one  million  of  bis  friends. 

The  works  of  Homer  are  supposed  to  have  done  great  injury  to 
mankind  by  inspiring  the  love  of  military  glory.  Alexander  was 
said  to  sleep  with  them  always  on  his  pillow.  How  like  a mad 


Class  III.  1.  2.  10, 


OP  VOLITION. 


317 


butcher  amidst  a flock  of  sheep  appears  the  hero  of  the  Iliad,  in 
the  following  fine  lines  of  Mr.  Pope,  which  conclude  the  twen- 
tieth book. 

His  fiery  coursers,  as  the  chariot  rolls, 

Tread  down  whole  ranks  and  crush  out  heroes’  souls; 

Dash’d  from  their  hoofs,  as  o’er  the  dead  they  fly. 

Black  bloody  drops  the  smoking  chariot  die  ; — 

The  spiky  wheels  through  heaps  of  carnage  tore. 

And  thick  the  groaning  axles  dropp’d  with  gore ; 

High  o’er  the  scene  of  death  Achillbs  stood. 

All  grim  with  dust,  all  horrible  with'  blood-; 

Yet  still  insatiate,  still  with  rage  on  flame. 

Such  is  the  lust  of  never  dying  fame  ! 

The  cure  must  be  taken  from  moral  writers.  Woolaston  says, 
Cajsar  conquered  Pompey;  that  is,  a man  whose  name  consisted 
of  the  letters  C,  se,  s,  a,  r,  conquered  a long  time  ago  a man, 
whose  name  consisted  of  the  letters  P,  o,  m,  p,  e,  y,  and  that  this 
is  all  that  remains  of  either  of  them.  Juvenal  also  attacks  this 
mode  of  insanity,  Sat.  X.  166. 

I,  demens,  et  sjevas  curre  per  Alpes, 

Ut  pueris  placeas,  et  declamatio  lias  ' 

Which  is  thus  translated  by  Dr.  Johnson, 

And  left  a name,  at  which  the  world  grew  pale, 

To  point  a moral,  or  adorn  a tale  ! 

10.  Mozror.  Grief.  A perpetual  voluntary  contemplation 
of  all  the  circumstances  of  some  great  loss,  as  of  a favourite 
child.  In  general  the  painful  ideas  gradually  decrease  in  energy, 
and  at  length  the  recollection  becomes  more  tender  and  less 
painful.  The  letter  of  Sulpicius  to  Cicero  on  the  loss  of  his 
daughter,  is  ingenious.  The  example  of  David  on  the  loss  of  his 
/ child  is  heroic. 

A widow  lady  was  left  in  narrow  circumstances  with  a boy 
and  a girl,  two  beautiful  and  lively  children,  the  one  six,  and 
the  other  seven  years  of  age;  as  her  circumstances  allowed  her 
to  keep  but  one  maid-servant,  these  two  children  were  the  sole 
attention,  employment,  and  consolation  of  her  life;  she  fed 
them,  dressed  them,  slept  with  them,  and  taught  them  herself; 
they  were  both  snatched  from  her  by  the  gangrenous  sore  throat 
in  one  week:  so  that  she  lost  at  once  all  that  employed  her,  as 
wrell  as  all  that  was  dear  to  her.  For  the  first  three  or  four 
days  after  their  death,  when  any  friend  visited  her,  she  sat  up- 
right, with  her  eyes  wide  open,  without  shedding  tears,  and  af- 
fected to  speak  of  indifferent  things.  Afterwards  she  began  to 
weep  much,  and  for  some  weeks  talked  to  her  friends  of  nothing 


318 


DISEASES 


Glass  III.  1.2.  11. 


else  but  her  dear  children.  But  did  not  for  many  years,  even 
to  her  dying  hour,  get  quite  over  a gloom,  which  was  left  upon 
her  countenance. 

In  violent  grief,  when  tears  flow,  it  is  esteemed  a good  symp- 
tom; because  then  the  actions  caused  by  sensitive  association 
take  the  place  of  those  caused  by  volition;  that  is,  they  prevent 
the  voluntary  exertions  of  ideas,  or  muscular  actions,  which  con- 
stitute insanity. 

The  sobbing  and  sighing  attendant  upon  grief  are  not  convul- 
sive movements,  they  are  occasioned  by  the  sensorial  power  be- 
ing so  expended  on  the  painful  ideas,  and  their  connexions,  that 
the  person  neglects  to  breathe  for  a time,  and  then  a violent  sigh 
or  sob  is  necessary  to  carry  on  the  blood,  wdiich  oppresses  the 
pulmonary  vessels,  which  is  then  performed  by  deep  or  quick  in- 
spirations, and  laborious  expirations.  Sometimes,  nevertheless, 
the  breath  is  probably  for  a while  voluntarily  held,  as  an  effort 
to  relieve  pain.  The  paleness  and  ill  health  occasioned  by  long 
grief  are  spoken  of  in  Class  IV.  2.  1.  9. 

The  melioration  of  grief  by  time,  and  its  being  at  length  even 
attended  with  pleasure,  depends  on  our  retaining  a distinct  idea 
of  the  lost  object,  and  forgetting  for  a time  the  idea  of  the  loss 
of  it.  This  pleasure  of  grief  is  beautifully  described  by  Aken- 
^ide.  Pleasures  of  Imagination,  Book  II.  1.  6S0. 

Ask  the  faithful  youth, 

Why  the  cold  urn  other,  whom  long  he  loved. 

So  often  fills  his  arms;  so  often  draws 
Ilis  lonely  footsteps  at  the  silent  hour, 

To  pay  the  mournful  tribute  of  his  tears  r 
Oh  ! he  will  tell  thee,  that  the  wealth  of  worlds 
Should  ne’er  seduce  his  bosom  to  forego 
That  sacred  hour;  when,  stealing  from  the  noise 
Of  care  and  envy,  sweet  remembrance  soothes 
With  Virtue’s  kindest  looks  his  aching  breast. 

And  turns  his  tears  to  rapture. 


M.  M.  Consolation  is  best  supplied  by  the  Christian  doctrine 
of  a happy  immortality.  In  the  Pagan  religion  the  power  of 
dying  was  the  great  consolation  in  irremediable  distress.  Seneca 
says,  “ no  one  need  be  unhappy  unless  by  his  own  fault.'1  And 
the  author  of  Telemachus  begins  bis  work  by  saying,  that  Ca- 
lypso could  not  console  herself  for  the  loss  of  Ulysses,  and  found 
herself  unhappy  in  being  immortal.  In  the  first  hours  ot  grief 
the  method  of  consolation  used  by  uncle  Toby,  in  Tristram 
Shandy,  is  probably  the  best;  “ he  sat  down  in  an  arm  chair  by 
the  bed  of  his  distressed  friend,  and  said  nothing.’ 

11.  Tcedium  vita.  Ennui.  Irksomeness  of  lite.  The  ina- 
nity of  sublunary  things  has  afforded  a theme  to  philosophers. 


Class  m.  1.  2.  11. 


OF  VOLITION. 


ais 

moralists,  and  divines,  from  the  earlierst  records  of  antiquity: 
“ Vanity  of  vanities!”  says  the  preacher,  “ all  is  vanity!”  Solo- 
mon. “ Man  is  the  dream  of  a shadow!”  2*^ s ssv^sros. 

Pindar.  0!  quantam  est  in  rebus  inane!  Juvenal.  Nor  is  there 
any  one,  I suppose,  who  has  passed  the  meridian  of  life,  who  has 
not  at  some  moments  felt  the  nihility  of  all  things. 

Weariness  of  life,  or  ennui  in  its  moderate  degree,  has  been 
esteemed  a motive  to  action  by  some  philosophers.  See  Sect. 
XXXIV.  2.  3.  But  in  those  men,  who  have  run  through  the 
usual  amusements  of  life  early  in  respect  of  their  age;  and  who 
have  not  industry  or  ability  to  cultivate  those  sciences,  which  af- 
ford a perpetual  fund  of  novelty,  and  of  consequent  entertain- 
ment, are  liable  to  become  tired  of  life,  as  they  suppose  there  is 
nothing  new  to  be  found  in  it,  that  can  afford  them  pleasure;  like 
Alexander,  who  is  said  to  have  shed  tears  because  he  had  not 
another  world  to  conquer. 

Mr. , a gentleman,  about  fifty,  of  polished  manners, 

who  in  a few  months  afterwards  destroyed  himself,  said  to  me 
one  day,  “ A ride  out  in  the  morning,  and  a warm  parlour  aud 
a pack  of  cards  in  the  afternoon,  are  all  that  life  affords.”  He 
was  persuaded  to  have  an  issue  on  the  top  of  his  head,  as  he  com- 
plained of  a dull  head-ach,  which  being  unskilfully  managed, 
destroyed  the  pericranium  to  the  size  of  an  inch  in  diameter; 
during  the  time  this  took  in  healing,  he  was  indignant  about  it, 
and  endured  life,  but  soon  afterwards  shot  himself. 

Mr. , a gentleman  of  Gray’s  Inn,  some  years  ago  was  pre- 

vailed upon  by  his  friends  to  dismiss  a mistress,  by  whom  he  had 
a child,  but  who  was  so  great  a termagant  and  scold,  that  she  was 
believed  to  use  him  very  ill,  and  even  to  beat  him.  He  became 
melancholy  in  two  days  from  the  want  of  his  usual  stimulus  to 
action,  and  cut  his  throat  on  the  third  so  completely,  that  he  died 
immediately. 

Mr.  Anson,  the  brother  to  the  late  lord  Anson,  related  to  me 

the  following  anecdote  of  the  death  of  lord  Sc . His  lord- 

ship  sent  to  see  Mr.  Anson  on  the  Monday  preceding  his  death, 
and  said,  “ You  are  the  only  friend  I value  in  the  world,  I de- 
termined therefore  to  acquaint  you,  that  I am  tired  of  the  insipi- 
dity of  life,  and  intend  to-morrow  to  leave  it.”  Mr.  Anson  said, 
after  much  conversation,  that  he  was  obliged  to  leave  town  till 
Friday,  and  added,  “ As  you  profess  a friendship  for  me,  do 
me  this  last  favour,  I entreat  you,  live  till  I return.”  Lord 
Sc believed  this  to  be  a pious  artifice  to  gain  time,  but  ne- 

vertheless agreed,  if  he  should  return  by  four  o’clock  on  that  day. 
Mr.  Anson  did  not  return  till  five,  and  perceived  by  the  coun- 
tenances of  the  domestics,  that  the  deed  was  done,  He  went 


320 


DISEASES 


Class  III.  1.  2.  li. 


into  his  chamber  and  found  the  corpse  of  his  friend  leaning  over 
the  arm  of  a great  chair,  with  the  pistol  on  the  ground  by  him. 
the  ball  of  which  had  been  discharged  into  the  roof  of  his  mouth, 
and  passed  into  his  brain. 

Mr. and  Mr. , two  young  men,  heirs  to  considerable 

fortunes,  shot  themselves  at  the  age  of  four  or  five  and  twenty, 
without  their  friends  being  able  to  conjecture  any  cause  for  those 
rash  actions.  One  of  them  I had  long  known  to  express  himself 
with  dissatisfaction  of  the  world;  at  eighteen  years  of  age  he 
complained,  that  he  could  not  entertain  himself;  he  tried  to 
study  the  law  at  Cambridge,  and  afterwards  went  abroad  for  a 
year  or  two  by  my  advice;  but  returned  dissatisfied  with  all 
things.  As  he  had  an  eruption  for  some  years  on  a part  of  his 
face,  which  he  probably  endeavoured  to  remove  by  external  ap- 
plications; I was  induced  to  ascribe  his  perpetual  ennui  to  the 
pain  or  disagreeable  sensation  of  a diseased  liver.  The  other 
young  gentleman  shot  himself  in  his  bed-room,  and  I was  in- 
formed that  there  was  found  written  on  a scrap  of  paper  on  his 
table,  “ I am  impotent,  and  therefore  not  fit  to  live.”  From 
whence  there  was  reason  to  conclude,  that  this  was  the  halluci- 
natio  maniacalis,  the  delirious  idea,  which  caused  him  to  destroy 
himself.  The  case  therefore  belongs  to  mania  mutabilis,  and  not 
to  taedium  vitae. 

Those  who  have  been  employed  during  the  first  half  of  their 
lives  in  some  very  active  business,  and  suddenly  leave  it,  are  li- 
able to  this  kind  of  insanity,  and  even  to  suicide;  of  which  1 have 
known  two  instances,  one  of  them  a Birmingham  manufacturer, 
and  the  other  a great  and  successful  commander.  This  may  be 
ascribed  to  the  accumulation  of  the  sensorial  power  of  volition, 
and  the  want  of  motive  to  exert  or  expend  it,  and  which  thence 
becomes  painful.  See  pain  of  cold  from  the  want  of  stimulus. 
III.  2.  1.  17. 

This  may  afford  consolation  to  those,  whose  situation  in  lift 
obliges  them  to  use  perpetual  industry  in  their  occupations:  they 
may  say,  that  as  they  have  been  long  in  the  habit  of  exerting 
much  voluntary  action,  they  must  continue  to  employ  themselves; 
otherwise  that  they  shall  sink  into  low  spirits,  as  it  is  called,  and 
become  unhappy.  And  as  the  continuance  of  activity  is  now 
necessary  to  their  happiness,  they  had  better  employ  themselves 
on  such  objects,  as  are  useful  to  themselves  or  their  connections, 
than  to  consume  their  time,  and  misapply  their  labour,  in  card- 
playing, wine-drinking,  or  fox-hunting,  which  are  other  methods 
of  relieving  ennui,  or  the  irksomeness  of  life  by  exertion,  and  con- 
sequent expenditure  of  voluntary  power. 

Less  degrees  of  this  malady  are  erroneously  termed  hypochon- 


Class  III.  1.  2. 11. 


OF  VOLITION. 


321 


driacism,  see  Class  I.  2.  4.  10.  by  the  people,  and  are  generally 
ascribed  to  the  want  of  voluntary  power,  or  of  industry;  but  I 
believe  it  is  generally  owing  to  want  of  motive  or  stimulus;  and 
that  the  pain  attending  this  state  of  our  ideas  or  muscles  is  occa- 
sioned by  accumulation  of  voluntary  power,  as  above  mentioned. 
The  cure  of  this  disease,  is  popularly  known  to  consist  in  any 
kind  of  voluntary  exertion  of  the  mind,  or  of  the  body;  one  of 
our  poets  has  personified  hypochondriacism,  and  well  advises  the 
use  of  exercise,  or  exertion  to  oppose  the  monster,  and  says, 

“ Throw  but  a stone  the  giant  dies.” 

To  this  should  be  added,  that  those  who  have  been  educated 
in  indolence,  do  not  find  or  feel  ennui,  or  the  pain  of  existence, 
when  they  are  inactive;  like  our  domestic  animals,  as  dogs  and 
cats,  who  sleep  by  the  fire  without  inclination  to  hang  or  drown 
themselves;  as  these  beings,  not  having  been  long  accustomed  to 
expend  much  voluntary  power,  are  not  liable  to  much  accumula- 
tion of  it,  and  uneasiness  in  consequence;  w'hich  is  not  so,  how- 
ever, with  the  more  active  squirrel  before  mentioned. 

But,  on  the  contrary,  those  whose  education  has  induced  them 
to  use  much  voluntary  exertion,  and  have  afterwards  had  no  ac- 
tive employment,  as  happens  to  some  unmarried  ladies,  are  more 
liable,  as  I have  repeatedly  witnessed,  to  this  malady;  an  idea, 
which  should  be  attended  to  in  female  education. 

Another  source  of  ennui  or  tasdium  vitte,  is  also  derived  from 
wrong  education,  and  is  immediately  owing  to  the  want  of  stimu- 
lus rather  than  to  the  great  accumulation  of  voluntary  power; 
and  is  liable  to  attend  some  ladies  in  high  life,  whose  exertions 
during  their  early  years  were  excited  by  the  flattery  of  numerous 
menial  servants.  And  afterwards,  when  this  flattery  ceases  by 
their  living  with  their  equals,  they  want  their  accustomed  motive 
to  activity,  and  in  consequence  become  indolent  and  unhappy,  as 
further  described  in  Class  III.  2. 1. 8.  under  the  name  of  Paresis 
voluntaria. 

M.  M.  The  prevention  of  this  malady  must  consist  in  the  due 
care  of  education.  Those  who  are  not  designed  for  very  active 
life,  particularly  young  ladies,  should  not  be  forced  in  their  early 
years  to  use  too  violent  or  too  constant  voluntary  exertions.  They 
should  not  be  flattered  into  all  their  exertions,  but  should  be 
taught  to  act  from  duty  to  themselves  and  others,  or  for  their  fu- 
ture advantage  as  well  as  for  their  present  amusement. 

Some  restraint  in  exhausting  the  usual  pleasures  of  the  world 
in  early  life  should  be  laid  on  young  men  of  fortune;  and  after- 
wards the  pleasures  and  solicitudes  of  a matrimonial  life  are 

VOL.  II.  Tt 


322 


DISEASES 


Class  III.  1.  2.  12. 


strongly  to  be  recommended;  and  finally  the  cultivation  of  sci- 
ence, as  of  chemistry,  natural  philosophy,  natural  history,  which 
supplies  an  inexhaustible  source  of  pleasurable  novelty,  and  re- 
lieves ennui  by  the  exertions  it  occasions. 

In  many  of  these  cases,  when  irksomeness  of  life  has  been  the 
ostensible  cause  of  suicide,  there  has  probably  existed  a maniacal 
hallucination,  a painful  idea,  which  the  patient  has  concealed 
even  to  his  dying  hour;  except  where  the  mania  has  evidently 
arisen  from  hereditary  or  acquired  disease  of  the  membranous  or 
glandular  parts  of  the  system. 

12.  Pulchritudinis  desiderium.  The  loss  of  beauty,  either  by 
disease,  as  by  the  small-pox,  or  by  age,  as  life  advances,  is  some- 
times painfully  felt  by  ladies,  who  have  been  much  flattered  on 
account  of  it  There  is  a curious  case  of  this  kind  related  in  Le 
Sage’s  Bachelor  of  Salamanca,  which  is  too  nicely  described  to 
be  totally  imaginary. 

In  this  situation,  some  ladies  apply  to  what  are  termed  cosme- 
tics under  various  names,  which  crovtd  the  newspapers.  Of  ihese 
the  white  has  destroyed  the  health  of  thousands;  a calx,  or  ma- 
gistery,  of  bismuth  is  supposed  to  be  sold  in  the  shops  for  this 
purpose;  but  it  is  either,  I am  informed,  in  part  or  entirely  white 
lead  or  cerussa.  The  pernicious  effects  of  the  external  use  of 
those  saturnine  applications  are  spoken  of  in  gutta  rosea,  Class 
II.  1. 4.  6.  The  real  calx  of  bismuth  would  probably  have  the 
same  ill  effect.  As  the  red  paint  is  prepared  from  cochineal, 
which  is  an  animal  body,  less  if  any  injury  arises  from  its  use,  as 
it  only  lies  on  the  skin  like  other  filth. 

The  tan  of  the  skin  occasioned  by  the  sun  may  be  removed  by 
lemon  juice  evaporated  by  the  fire  to  half  its  original  quantity, 
or  by  diluted  marine  acid;  which  cleans  the  cuticle,  by  eroding 
its  surface,  but  requires  much  caution  in  the  application;  the  ma- 
rine acid  must  be  diluted  with  water,  and  then  put  upon  the 
hand  or  face,  after  a second  of  time;  as  soon  as  the  tan  disappears, 
the  part  must  be  washed  writh  a wet  towel  and  much  warm 
water.  Freckles  lie  too  deep  for  this  operation,  nor  are  they  in 
general  removable  by  a blister,  as  I once  experienced.  See  Class 
I.  2.  2.  9. 

It  is  probable,  that  those  materials  which  stain  silk,  or  ivory, 
might  be  used  to  stain  the  cuticle,  or  hair,  permanently;  as  they 
are  all  animal  substances.  But  I do  not  know,  that  any  trials  of 
this  kind  have  been  made  on  the  skin.  I endeavoured  in  vain  to 
whiten  the  back  of  my  hand  by  marine  acid  oxygenated  by  man- 
ganese, which  so  instantly  whitens  cotton. 

The  cure,  therefore,  must  be  sought  from  moral  writers,  and 


OF  VOLITION. 


Class  III.  1.  2. 13. 


323 


the  cultivation  of  the  graces  of  the  mind,  which  are  frequently  a 
more  valuable  possession  than  celebrated  beauty. 

13.  Paupertatis  lintor  The  fear  of  poverty  is  one  kind  of 
avarice;  it  is  liable  to  affect  people  who  have  left  off  a profitable 
and  active  business;  as  they  are  thus  deprived  of  their  usual  exer- 
tions, and  are  liable  to  observe  the  daily  expenditure  of  money, 
without  calculating  the  source  from  whence  it  flows.  It  is  also 
liable  to  occur  with  a sudden  and  unexpected  increase  of  fortune. 

Mr. , a surgeon,  about  fifty  years  of  age,  who  was  always 

rather  of  a parsimonious  disposition,  had  a large  house,  with  a 
fortune  of  forty  thousand  pounds,  left  him  by  a distant  relation; 
and  in  a few  weeks  became  insane  from  the  fear  of  poverty,  la- 
menting that  he  should  die  in  a jail  or  a workhouse.  He  had  left 
off  a laborious  country  business,  and  the  daily  perception  of  profit 
in  his  books;  he  also  now  saw  greater  expenses  going  forwards  in 
his  new  house,  than  he  had  been  accustomed  to  observe,  and  did 
not  so  distinctly  see  the  source  of  supply;  which  seems  to  have 
occasioned  the  maniacal  hallucination.  This  idea  of  approach- 
ing poverty  is  a very  frequent  and  very  painful  disease,  so  as  to 
have  induced  many  to  become  suicides,  who  were  in  good  cir- 
cumstances; more  perhaps  than  any  other  maniacal  hallucina- 
tion, except  the  fear  of  Hell. 

The  covetousness  of  age  is  more  liable  to  affect  single  men, 
than  those  who  have  families;  though  an  accumulation  of  wealth 
would  seem  to  be  more  desirable  to  the  latter.  But  an  old  man 
in  the  former  situation,  has  no  personal  connections  to  induce 
him  to  open  his  purse;  and  having  lost  the  friends  of  his  youth, 
and  not  easily  acquiring  new  ones,  feels  himself  alone  in  the 
world:  feels  himself  unprotected,  as  his  strength  declines,  and  is 
thus  led  to  depend  for  assistance  on  money,  and  on  that  account 
wishes  to  accumulate  it.  Whereas  the  father  of  a family  has  not 
only  those  connections,  which  demand  the  frequent  expenditure 
of  money,  but  feels  a consolation  in  the  friendship  of  his  children, 
when  age  may  render  their  good  offices  necessary  to  him. 

M.  M.  I have  been  well  informed  of  a medical  person  in  good 
circumstances  in  London,  who  always  carries  an  account  of  his 
affairs,  as  debtor  and  creditor,  in  his  pocket-book;  and  looks  over 
it  frequently  in  a day,  when  this  disease  returns  upon  him;  and 
thus,  by  counteracting  the  maniacal  hallucination,  wisely  prevents 
the  increase  of  his  insanity.  Another  medical  person,  in  London, 
is  said  to  have  cured  himself  of  this  disease  by  studying  mathe- 
matics with  great  attention;  which  exertion  of  the  mind  relieved 
the  pain  of  the  maniacal  hallucination. 

Many  moral  writers  have  stigmatised  this  insanity;  the  covetous, 


824 


DISEASES 


Class  III.  1.  2.  14. 


they  say,  commit  crimes  and  mortify  themselves  without  hopes  of 
reward;  and  thus  become  miserable  both  in  this  world  and  the 
next.  Thus  Juvenal; 

Cum  furor  baud  dubius,  cum  sit  manifesta  phrenitis, 

Ut  locuples  moriaris,  egenli  vivere  fato  ! 

The  covetous  man  thought  he  gave  good  advice  to  the  spend- 
thrift, when  he  said,  “ Live  like  me,”  who  well  answered  him. 

“ Like  you.  Sir  John  ? 

“ That  I can  do,  when  all  I have  is  gone  !” 

Pope. 

14.  Lethi  timor.  The  fear  of  death  perpetually  employs  the 
thoughts  of  these  patients:  hence  they  are  devising  new  medi- 
cines, and  applying  to  physicians  and  quacks  without  number.  It 
is  confounded  with  hypochondriasis.  Class  I.  2.  3.  9.  in  popular 
conversation,  but  is  in  reality  an  insanity. 

A young  gentleman,  whom  I advised  to  go  abroad  as  a cure  for 
this  disease,  assured  me,  that  during  the  three  years  he  was  in 
Italy  and  France  he  never  passed  a quarter  of  an  hour  without 
fearing  he  should  die.  But  he  has  now  for  above  twenty  years 
experienced  the  contrary. 

The  sufferers  under  this  malady  are  generally  at  once  discover- 
able by  their  telling  you,  amidst  an  unconnected  description  of 
their  complaints,  that  they  are  nevertheless  not  afraid  of  dying. 
They  are  also  easily  led  to  complain  of  pains  in  almost  any  part 
of  the  body,  and  are  thus  soon  discovered. 

M.  M.  As  the  maniacal  hallucination  has  generally  arisen  in 
early  infancy  from  some  dreadful  account  of  the  struggles  and 
pain  of  dying,  I have  sometimes  observed,  that  these  patients 
have  received  great  consolation  from  the  instances  I have  re- 
lated to  them  of  people  dying  without  pain.  Some  of  these, 
which  I think  curious,  I shall  concisely  relate,  as  a part  of  the 
method  of  cure. 

Mr. , an  elderly  gentleman,  had  sent  for  me  one  whole 

day  before  I could  attend  him;  on  my  arrival  he  said  he  was 
glad  to  see  me,  but  that  be  was  now  quite  well,  except  that  he 
was  weak,  but  had  had  a pain  in  his  bowels  the  day  before.  He 
then  lay  in  bed  with  his  legs  cold  up  to  the  knees,  his  hands 
and  arms  cold,  and  his  pulse  scarcely  discernible,  and  died  in 

about  six  hours.  Mr. , another  gentleman  about  sixty,  lay  in 

the  act  of  dying,  with  difficult  respiration  like  groaning,  but  in  a 
kind  of  stupor  or  coma  vigil,  and  every  ten  or  twelve  minutes, 
while  I sat  by  him,  he  wraked,  looked  up,  and  said,  “ who  is  it 


Ciass  ni.  1.  2-  lo. 


OF  VOLITION. 


325 


groans  so,  I am  sure  there  is  somebody  dying  in  the  room,”  and 
then  sunk  again  into  a kind  of  sleep.  From  these  two  cases  there 
appeared  to  be  no  pain  in  the  act  of  dying,  which  may  afford  con- 
solation to  all,  but  particularly  to  those  who  are  afflicted  with  the 
fear  of  death. 

15.  Orcitimor.  The  fear  of  Hell.  Many  theatric  preachers 
among  the  Methodists  successfully  inspire  this  terror,  and  live 
comfortably  upon  the  folly  of  their  hearers.  In  this  kind  of  mad- 
ness the  poor  patients  frequently  commit  suicide;  although  they 
believe  they  run  headlong  into  the  Hell,  which  they  dread!  Such 
is  the  power  of  oratory,  and  such  the  debility  of  the  human  un- 
derstanding! 

Those  who  suffer  under  this  insanity,  are  generally  the  most 
innocent  and  harmless  people;  who  are  then  liable  to  accuse 
themselves  of  the  greatest  imaginary  crimes,  and  have  so  much 
intellectual  cowardice,  that  they  dare  not  reason  about  those 
things,  which  they  are  directed  by  their  priest  to  believe,  how- 
ever contradictory  to  human  apprehension,  or  derogatory  to  the 
great  Creator  of  all  things.  The  maniacal  hallucination  at 
length  becomes  so  painful,  that  the  poor  insane  flies  from  life  to 
become  free  from  it. 

M.  M.  Where  the  intellectual  cowardice  is  great,  the  voice 
of  reason  is  ineffectual:  but  that  of  ridicule  may  save  many 
from  those  mad-making  doctors;  though  it  is  too  weak  to  cure 
those  who  are  already  hallucinated.  Foote’s  Farces  are  recom- 
mended for  this  purpose. 

16.  Satyriasis.  An  ungovernable  desire  of  venereal  indul- 
gence. The  remote  cause  is  probably  the  stimulus  of  the  se- 
men; whence  the  phallus  becomes  distended  with  blood  by  the 
arterial  propulsion  of  it  being  more  strongly  excited  than  the  cor- 
respondent venous  absorption.  At  the  same  time  a new  sense  is 
produced  in  the  other  termination  of  the  urethra;  which,  like 
itching,  requires  some  exterior  friction  to  facilitate  the  removal 
of  the  cause  of  the  maniacal  actions,  which  may  probably  be  in- 
creased in  those  cases  by  some  associated  hallucinations  of  ideas. 
It  differs  from  priapismus  chronicus  in  the  desire  of  its  appro- 
priated object,  which  is  not  experienced  in  the  latter,  Class  I. 
1.  4.  6.  and  from  the  priapismus  amatorius,  Class  II.  1.7.  9.  in 
the  maniacal  actions  in  consequence  of  desire.  The  furor  uteri- 
nus,  or  nymphomania,  is  a similar  disease. 

M.  M.  Venesection.  Cathartics.  Torpentia.  Marriage. 

17.  Ira.  Anger  is  caused  by  offended  pride.  We  are  not 
angry  at  breaking  a bone,  but  become  quite  insane  from  the 
smallest  stroke  of  a whip  from  an  inferior.  Ira  furor  brevis.  An- 
ger is  not  only  itself  a temporary  madness,  but  is  a frequent  at- 


32  G 


DISEASES 


Class  III.  1.  2.  18. 


tendant  on  other  insanities,  and  as,  whenever  it  appears,  it  dis- 
tinguishes insanity  from  delirium,  it  is  generally  a good  sign  in 
fevers  with  debility. 

An  injury  voluntarily  inflicted  on  us  by  others  excites  our  ex- 
ertions of  self-defence  or  of  revenge  against  the  perpetrator  of  it; 
but  anger  does  not  succeed  in  any  great  degree  unless  our  pride  is 
offended;  this  idea  is  the  maniacal  hallucination,  the  pain  of  which 
sometimes  produces  such  violent  and  general  exertions  of  our 
muscles  and  ideas,  as  to  disappoint  the  revenge  we  medi  ate,  and 
vainly  to  exhaust  our  sensorial  power.  Hence  angry  p ople,  if 
not  further  excittd  by  disagreeable  language,  are  liable  in  an  hour 
or  two  to  become  humble,  and  sorry  for  their  violence,  and  will- 
ing to  make  greater  concessions  than  required. 

M.  M.  Be  silent  when  you  feel  yourself  angry.  Never  use 
loud  oaths,  violent  upbraidings,  or  strong  expressions  of  counte- 
nance, or  gesticulations  of  the  arms,  or  clenched  fists;  as  these 
by  their  former  associations  with  anger  will  contribute  to  in- 
crease it.  I have  been  told  of  a sergeant  or  corporal,  who  be- 
gan moderately  to  cane  his  soldiers,  when  they  were  awkward 
in  their  exercise,  but  being  addicted  to  swearing  and  coarse  lan- 
guage, he  used  soon  to  enrage  himself  by  his  own  expressions  of 
anger,  till  toward  the  end  he  was  liable  to  beat  the  delinquents 
unmercifully. 

18.  Rabies.  Rage.  A desire  of  biting  others,  most  frequently 
attendant  on  canine  madness.  Animals  in  great  pain,  as  in  the 
colica  saturnina,  are  said  to  bite  the  ground  they  lie  upon,  and 
even  their  own  flesh.  I have  seen  patients  bite  the  attendants, 
and  even  their  own  arms,  in  the  epilepsia  dolorifica.  It  seems 
to  be  an  exertion  to  relieve  pain,  as  explained  in  Sect.  XXXIV. 
1.  3.  The  dread  of  water  in  hydrophobia  is  occasioned  by  the 
repealed  painful  attempts  to  swallow  it,  and  is  therefore  not  an 
essential  or  original  part  of  the  disease  called  canine  madness. 
See  Class  III.  1.1.  15. 

There  is  a mania  reported  to  exist  in  some  parts  of  the  east,  in 
which  a man  is  said  to  run  a muck;  and  these  furious  maniacs 
are  believed  to  have  induced  their  calamity  by  unlucky  gaming, 
and  afterwards  by  taking  large  quantities  of  opium;  whence  the 
pain  of  despair  is  joined  with  the  energy  of  drunkenness;  they  are 
then  said  to  sally  forth  into  the  most  populous  streets,  and  to 
wound  and  slay  all  they  meet,  till  they  receive  their  own  death, 
which  they  desire  to  procure  without  the  greater  guilt,  as  they 
suppose,  of  suicide. 

M.  M.  When  there  appears  a tendency  to  bite  in  the  pain- 
ful epilepsy,  the  end  of  a rolled  up  towel,  or  a wedge  of  soft 
wood,  should  be  put  into  the  mouth  of  the  patient.  As  a bulle: 


CkassTII.  1.2.  19. 


OF  VOLITION. 


327 


is  said  sometimes  to  be  given  to  a soldier,  who  is  to  be  severely 
flogged,  that  he  may,  by  biting  it,  better  bear  his  punishment. 

19.  Citta.  A desire  to  swallow  indigestible  substances.  I 
once  saw  a young  lady,  about  ten  years  of  age,  who  filled  her 
stomach  with  the  earth  out  of  a flower-pot,  and  vomited  it  up 
with  small  stones,  bits  of  wood,  and  wings  of  insects  amongst  it. 
She  had  the  bombycinous  complexion,  and  looked  like  a chloro- 
tic patient,  though  so  young;  this  generally  proceeds  from  an  acid 
in  the  stomach. 

M.  M.  A vomit.  Magnesia  alba.  Armenian  bole.  Rhu- 
barb. Bark.  Steel.  A blister.  See  Class  I.  2.  4.  5. 

20.  Cacositia.  Aversion  to  food.  This  may  arise,  without 
disease  of  the  stomach,  from  connecting  nauseous  ideas  to  our 
usual  food,  as  by  calling  a ham  a hog’s  a— —tv  This  madness  is 
much  inculcated  by  the  stoic  philosophy.  See  Antoninus’  Me- 
ditations. See  two  cases  of  patients  who  refused  to  take  nou- 
rishment, Class  III.  1.2.  1. 

Aversions  to  peculiar  kinds  of  food  are  thus  formed  early  in 
life,  bv  association  of  some  maniacal  hallucination  with  them;  I 
remember  a child,  who,  on  tasting  the  gristle  of  sturgeon,  asked 
what  gristle  was?  And  being  told  it  was  like  the  division  of  a 
man’s  nose,  received  an  ideal  hallucination;  and  for  twenty  years 
afterwards  could  not  be  persuaded  to  last*  sturgeon. 

The  great  fear  or  aversion,  which  some  people  experience  at 
the  sight  of  spiders,  toads,  crickets,  and  the  like,  have  generally 
had  a similar  origin. 

M.  M.  Associate  agreeable  ideas  with  those  which  disgust; 
as  call  a spider  ingenious,  a frog  clean  and  innocent;  and  repress 
all  expressions  of  disgust  by  the  countenance,  as  such  expressions 
contribute  to  preserve,  or  even  to  increase  the  energy  of  the  . 
ideas  associated  with  them;  as  mentioned  above  in  Species  17. 
Ira. 

21.  Syphilis  imaginarict.  The  fear  that  they  are  infected  with 
the  venereal  disease,  when  they  have  only  deserved  it,  is  a very 
common  insanity  amongst  modest  young  men;  and  is  not  to  be 
cured  without  applying  artfully  to  the  mind;  a little  mercury 
must  be  given,  and  hopes  of  a cure  added  weekly  and  gradually 
by  interview  or  correspondence  for  six  or  eight  weeks.  Many 
of  these  patients  have  been  repeatedly  salivated  without  curing 
the  mind! 

22.  Psora  hnaginaria.  I have  twice  seen  an  imaginary  itch, 
and  twice  an  imaginary  diabetes,  where  there  was  not  the  least 
vestige  of  either  of  those  diseases,  and  once  an  imaginary  deaf- 
ness, where  the  patient  heard  perfectly  well.  In  all  these  cases 
the  hallucinated  idea  is  so  powerfully  excited,  that  it  is  not  to  be 


328 


diseases 


Class  HI.  1.  2.  25 


changed  suddenly  by  ocular  sensation,  or  reason.  Yet  great  per- 
severance in  the  frequently  presenting  contrary  ideas  will  some- 
times slowly  remove  this  hallucination,  or  in  great  length  of  time 
oblivion,  or  forgetfulness,  performs  a cure,  by  other  means  in  vain 
attempted. 

23.  Tabes  imaginaria.  This  imaginary  disease,  or  hallucina- 
tion, is  caused  by  the  supposed  too  great  frequency  of  parting 
with  the  semen,  and  had  long  imposed  upon  the  physician  as 
well  as  the  patient,  till  Mr.  John  Hunter  first  endeavoured  to 
shew,  that  in  general  the  morbid  effects  of  this  pollution  wyere  in 
the  imagination;  and  that  those  were  only  liable  to  those  effects 
in  general,  who  had  been  terrified  by  the  villanous  books,  which 
pretend  to  prevent  or  to  cure  it,  but  which  were  purposely  writ- 
ten to  vend  some  quack  medicine.  Most  of  those  unhappy  pa- 
tients, whom  I have  seen,  had  evidently  great  impression  of  fear 
and  self-condemnation  on  their  minds,  and  might  be  led  to  make 
contradictory  complaints  in  almost  any  part  cf  the  body,  and  if 
their  confessions  could  be  depended  on,  had  not  used  this  pollu- 
tion to  any  great  excess. 

M.  M.  1.  Assure  them  if  the  loss  of  the  semen  happens  but 
twice  a week,  it  will  not  injure  them.  2.  Marry  them.  The 
last  is  a certain  cure;  whether  the  disease  be  real  or  imasinary. 
Cold  partial  bath,  and  astringent  medicines  frequently  taken,  only 
recall  the  mind  to  the  disease,  or  to  the  delinquency;  and  thence 
increase  the  imaginary  effects  and  the  real  cause,  if  such  exists. 

Mr. destroyed  himself  to  get  free  from  the  pain  of  fear  of 

the  supposed  ill  consequences  of  self-pollution,  without  anv  other 
apparent  disease;  whose  parents  I had  in  vain  advised  to  marry 
him,  if  possible. 

24.  Sympathia  aliena.  Pity.  Our  sympathy  with  the  plea- 
sures and  pains  of  others,  distinguishes  men  from  other  animals; 
and  is  probably  the  foundation  of  what  is  termed  our  moral  sense; 
and  the  source  of  all  our  virtues.  See  Sect.  XXII.  3.  3.  When 
our  sympathy  with  those  miseries  of  mankind,  which  we  cannot 
alleviate,  rises  to  excess,  the  mind  becomes  its  own  tormentor; 
and  we  add  to  the  aggregate  sum  of  human  misery,  which  we 
ought  to  labour  to  diminish;  as  in  the  following  eloquent  lamen- 
tation from  Akenside’s  Pleasures  of  Imagination,  Book  II.  1.  200 


Dark, 

As  midnight  storms,  the  scene  of  human  things 
Appear’d  before  me  ; deserts,  burning  sands, 
Where  the  parch’d  adder  dies ; the  frozen  south  ; 
And  desolation  blasting  all  the  west 
With  rapine  and  with  murder.  Tyrant  power 
Here  sits  enthroned  in  blood  ; the  baleful  charms 


Class  III.  1.  2.  25. 


OP  VOLITION. 


329 


Of  superstition  there  infect  the  skies. 

And  turn  the  sun  to  horror.  Gracious  Heaven  ! 

What  is  the  life  of  man  ? Or  cannot  these, 

Not  these  portents  thy  awful  will  suffice  ? 

That,  propagated  thus  beyond  their  scope. 

They  rise  to  act  their  cruelties  anew 
In  my  afflicted  bosom,  thus  decreed 
The  universal  sensitive  of  pain. 

The  wretched  heir  of  evils  not  its  own  ! 

A poet  of  antiquity,  whose  name  I do  not  recollect,  is  said  to 
have  written  a book  describing  the  miseries’ of  the  world,  and  to 
have  destroyed  himself  at  the  conclusion  of  his  task.  This  sym- 
pathy, with  all  sensitive  beings,  has  been  carried  so  far  by  some 
individuals,  and  even  by  whole  tribes,  as  the  Gentoos,  as  not 
only  to  restrain  them  from  killing  animals  for  their  support,  but 
even  to  induce  them  to  permit  insects  to  prey  upon  their  bodies. 
Such  is  however  the  condition  of  mortality,  that  the  first  law*  of 
nature  is,  “ Eat  or  be  eaten.”  We  cannot  long  exist  without 
the  destruction  of  other  animal  or  vegetable  beings,  either  in 
their  mature  or  their  embryon  state.  Unless  the  fruits,  which 
surround  the  seeds  of  some  vegetables,  or  the  honey  stolen  from 
them  by  the  bee,  may  be  said  to  be  an  exception  to  this  asser- 
tion. See  Botanic  Garden,  P.  I.  Cant.  I.  1.  218.  Note.  Hence, 
from  the  necessity  of  our  nature,  we  may  be  supposed  to  have  a 
right  to  kill  those  creatures,  which  ive  want  to  eat,  or  which 
want  to  eat  us.  But  to  destroy  even  insects  wantonly  shewrs  an 
unreflecting  mind  or  a depraved  heart. 

Nevertheless  mankind  may  be  well  divided  into  the  selfish  and 
the  social;  that  is,  into  those  whose  pleasures  arise  from  grati- 
fying their  appetites,  and  those  whose  pleasures  arise  from  their 
sympathising  with  others.  And  according  to  the  prevalence  of 
these  opposing  propensities  we  value  or  dislike  the  possessor  of 
them. 

In  conducting  the  education  of  young  people,  it  is  a nice 
matter  to  inspire  them  with  so  much  benevolent  sympathy,  or 
compassion,  as  may  render  them  good  and  amiable;  and  yet  not 
so  much  as  to  make  them  unhappy  at  the  sight  of  incurable  dis- 
tress. We  should  endeavour  to  make  them  alive  to  sympathize 
with  all  remediable  evils,  and  at  the  same  time  to  arm  them  with 
fortitude  to  bear  the  sight  of  such  irremediable  evils,  as  the  acci- 
dents of  life  must  frequently  present  before  their  eyes.  About 
this  I have  treated  more  at  large  in  a plan  for  the  conduct  of  a 
boarding-school  for  ladies,  which  I intend  to  publish  in  the 
course  of  the  next  year. 

25.  Educalio  heroica.  From  the  kinds  and  degrees  of  insani- 
ties already  enumerated,  the  reader  will  probably  recollect  many 

VOL.  n.  u u 


330 


DISEASES 


Ciass  III.  1.  2.  2l 


more  from  his  own  observation;  he  will  perceive  that  all  extra- 
ordinary exertions  of  voluntary  action  in  consequence  of  some 
false  idea  or  hallucination,  which  strongly  affects  us,  may  philo- 
sophically, though  not  properly,  he  termed  an  insanity;  he  will 
then  be  liable  to  divide  these  voluntary  exertions  into  disagree- 
able, pernicious,  detestable,  or  into  meritorious,  delectable,  and 
even  amiable,  insanities.  And  will  lastly  be  induced  to  conceive, 
that  a good  education  consists  id  the  art  of  producing  such  happy 
hallucinations  of  ideas,  as  may  be  followed  by  such  voluntary  ex- 
ertions, as  may  be  termed  meritorious  or  amiable  insanities. 

The  old  man  of  the  mountain  in  Syria,  who  governed  a small 
nation  of  people  called  Assassines,  is  recorded  thus  to  have  edu- 
cated those  of  his  army  who  were  designed  to  assassinate  the 
princes  with  whom  he  was  at  war.  A young  man  of  natural 
activity  was  chosen  for  the  purpose,  and  thrown  into  a deep 
sleep  by  opium  mixed  with  his  food;  he  was  then  carried  into 
a garden  made  to  represent  the  paradise  of  Mahomet,  with  flowers 
of  great  beauty  and  fragrance,  fruits  of  delicious  flavour,  and 
beautiful  Houries  beckoning  him  into  the  shades.  After  a while, 
on  being  a second  time  stupified  with  opium,  the  young  enthu- 
siast was  reconveyed  to  his  apartment;  and  on  the  next  day  was 
assured  by  a priest,  that  he  was  designed  for  some  great  exploit, 
and  that  by  obeying  the  commands  of  their  prince,  immortal  hap- 
piness awaited  him. 

Hence  it  is  easy  to  collect  how  the  first  impressions  made  on 
us  by  accidental  circumstances  in  our  infancy  continue  through 
life  to  bias  our  affections,  or  mislead  our  judgments.  One  of  my 
acquaintance  can  trace  the  origin  of  his  own  energies  of  action 
from  some  such  remote  sources,  which  justifies  the  observation  of 
M.  Rousseau,  that  the  seeds  of  future  virtues  or  vices  are  oftener 
sown  by  the  mother  than  the  tutor. 


Cuss.  III.  2. 1. 


OF  VOLITION. 


331 


ORDO  II. 

Increased  Volition. 

GENUS  I. 

With  decreased  Actions  of  the  Muscles. 

Our  muscles  become  fatigued  by  long  contraction,  and  cease 
for  a time  to  be  excitable  by  the  will;  owing  to  exhaustion  of 
the  sensorial  power,  which  resides  in  them.  After  a short  inter- 
val of  relaxation  the  muscle  regains  its  power  of  voluntary  con- 
traction; which  is  probably  occasioned  by  a new  supply  of  the 
spirit  of  animation.  In  weaker  people  these  contractions  cease 
sooner,  and  therefore  recur  more  frequently,  and  are  attended 
with  shorter  intervals  of  relaxation,  as  exemplified  in  the  quick- 
ness of  the  pulse  in  fevers  with  debility,  and  in  the  tremors  of 
the  hands  of  aged  or  feeble  people. 

After  a common  degree  of  exhaustion  of  the  sensorial  power 
in  a muscle,  it  becomes  again  gradually  restored  by  the  rest  of 
the  muscle,  and  even  accumulated  in  those  muscles,  which  are 
most  frequently  used;  as  in  those  which  constitute  the  capilla- 
ries of  die  skin  after  having  been  rendered  torpid  by  cold.  But 
in  chose  muscles,  which  are  generally  obedient  to  volition,  as 
those  of  locomotion,  though  their  usual  quantity  of  sensorial 
power  is  restored  by  their  quiescence,  or  in  sleep  (for  sleep  af- 
fects these  parts  of  the  system  only,)  yet  but  little  accumulation 
of  it  succeeds.  And  this  want  of  accumulation  of  the  sensorial 
power  in  these  muscles,  which  are  chiefly  subservient  to  voli- 
tion, explains  to  us  one  cause  of  their  greater  tendency  to  para- 
lytic affection. 

It  must  be  observed,  that  those  parts  of  the  system,  which 
have  been  for  a time  quiescent  from  want  of  stimulus,  as  the 
vessels  of  the  skin,  when  exposed  to  cold,  acquire  an  accumula- 
tion of  sensorial  power  during  their  inactivity;  but  this  does 
not  happen  at  all,  or  in  much  less  quantity,  from  their  quies- 
cence after  great  expenditure  of  sensorial  power  by  a previous 
excessive  stimulus,  as  after  intoxication.  In  this  case  the  mus- 
cles or  organs  of  sense  gradually  acquire  their  natural  quantity 
of  sensorial  power,  as  after  sleep;  but  not  an  accumulation  or 
superabundance  of  it.  And  by  frequent  repetitions  of  exhaus- 
tion by  great  stimulus,  these  vessels  cease  to  acquire  their  whole 
natural  quantity  of  sensorial  power;  as  in  the  scirrhous  sto- 
mach, and  scirrhous  liver,  occasioned  by  the  great  and  frequent 


332 


DISEASES 


Class  III.  2. 1.  I. 


stimulus  of  vinous  spirit;  which  may  properly  be  termed  irri- 
tative paralysis  of  those  parts  of  the  system. 

In  the  same  manner  in  common  palsies  the  inaction  of  the 
paralytic  muscle  seems  not  to  be  owing  to  defect  of  the  stimu- 
lus of  the  will,  but  to  exhaustion  of  sensorial  power.  Whence 
it  frequently  follows  great  exertion,  as  in  Sect.  XXXIV.  1.  7. 
Thus  some  parts  of  the  system  may  cease  to  obey  the  will,  as  in 
common  paralysis;  others  may  cease  to  be  obedient  to  sensation, 
as  in  the  impotency  of  age;  others  to  irritation,  as  in  scirrhous 
viscera;  and  others  to  association,  as  in  impediment  of  speech; 
yet  though  all  these  may  become  inexcitable,  or  dead,  in  respect 
to  that  kind  of  stimulus,  which  has  previously  exhausted  them, 
whether  of  volition,  or  sensation,  or  irritation,  or  association, 
they  may  still  in  many  cases  be  excited  by  the  others. 

SPECIES. 

1.  Lassitudo.  Fatigue  or  weariness  after  much  voluntary  ex- 
ertion. From  the  too  great  expenditure  of  sensorial  power  the 
muscles  are  with  difficulty  brought  again  into  voluntary  con- 
traction; and  seem  to  require  a greater  quantity  or  energy  of  vo- 
lition for  this  purpose.  At  the  same  time  they  still  remain  obe- 
dient to  the  stimulus  of  agreeable  sensation,  as  appears  in  tired 
dancers  finding  a renovation  of  their  aptitude  to  motion  on  the 
acquisition  of  an  agreeable  partner:  or  from  a tired  child  riding 
on  a gold-headed  cane,  as  in  Sect.  XXXIV.  2.  6.  These  mus- 
cles are  likewise  still  obedient  to  the  sensorial  power  of  associa- 
tion, because  the  motions  when  thus  excited,  are  performed  in 
their  designed  directions,  and  are  not  broken  into  variety  of  ges- 
ticulation, as  in  St.  Vitus’s  dance. 

A lassitude  likewise  frequently  occurs  with  yawning  at  the 
beginning  of  ague-fits;  where  the  production  of  sensorial  pow- 
er in  the  brain  is  less  than  its  expenditure.  For  in  this  case  the 
torpor  may  either  originate  in  the  brain,  or  the  torpor  of  some 
distant  parts  of  the  system  may  by  sympathy  affect  the  brain, 
though  in  a less  proportionate  degree  than  the  parts  primarily 
affected. 

2.  Vacillntio  senilis.  Some  elderly  people  acquire  a see-saw 
motion  of  their  bodies  from  one  side  to  the  other,  as  they  sit, 
like  the  oscillation  of  a pendulum.  By  these  motions  of  the  mus- 
cles, which  preserve  the  perpendicularity  of  the  body,  are  alter- 
nately quiescent,  and  exerted;  and  are  thus  less  liable  to  fatigue 
or  exhaustion.  This  therefore  resembles  the  tremors  of  old 
people  above  mentioned,  and  not  those  spasmodic  movements  of 
the  face  or  limbs,  which  are  called  tricks,  described  in  Class  IV. 


Class  III.  2.  1.  3. 


OF  VOLITION. 


333 


3.  2.  2.  which  originate  from  excess  of  sensorial  power,  or  from 
efforts  to  relieve  disagreeable  sensation,  and  are  afterwards  con- 
tinued by  habit. 

3.  Tremor  senilis.  Tremor  of  old  age  consists  of  a perpetual 
trembling  of  the  hands,  or  of  the  head,  or  of  other  muscles, 
when  they  are  exerted;  and  is  erroneously  called  paralytic;  and 
seems  owing  to  the  small  quantity  of  animal  power  residing  in 
the  muscular  fibres.  These  tremors  only  exist  when  the  affected 
muscles  are  excited  into  action,  as  in  lifting  a glass  to  the  mouth, 
or  in  writing,  or  in  keeping  the  body  upright;  and  cease  again, 
when  no  voluntary  exertion  is  attempted,  as  in  lying  down. 
Hence  these  tremors  evidently  originate  from  the  too  quick  ex- 
haustion of  the  lessened  quantity  of  the  spirit  of  anima  tion.  So 
many  people  tremble  from  fear  or  anger,  when  too  great  a part 
of  the  sensorial  power  is  exerted  on  the  organs  of  sense,  so  as  to 
deprive  the  muscles,  which  support  the  body  erect,  of  their  due 
quantity. 

4.  Brachionmi  paralysis.  A numbness  of  the  arms  is  a fre- 
quent symptom  in  hydrops  thoracis,  as  explained  in  Class  I.  2. 
3.  14.  and  in  Sect.  XXIX.  5.  2 .;  it  also  accompanies  the  asthma 
dolorificum,  Class  III.  1.  1.  11.  and  isowing  probably  to  the 
same  cause  in  both.  In  the  colica  saturnina  a paralysis  affects 
the  wrists,  as  appears  on  the  patient  extending  his  arm  horizon- 
tally with  the  palm  downwards,  and  is  often  attended  with  a tu- 
mour on  the  carpal  or  metacarpal  bones.  See  Class  IV.  2.2.  10. 
and  I.  2.  4.  8. 

Mr.  M , a miner  and  well-sinker,  about  three  years  ago, 

lost  the  power  of  contracting  both  his  thumbs;  the  balls  or  mus- 
cles of  the  thumbs  are  much  emaciated,  and  remain  paralytic. 
He  ascribes  his  disease  to  immersing  his  hands  too  long  in  cold 
water  in  the  execution  of  his  business.  He  says  his  hands  had 
frequently  been  much  benumbed  before,  so  that  he  could  not 
without  difficulty  clench  them;  but  that  they  recovered  their  mo- 
tion, as  soon  as  they  began  to  glow,  after  he  had  dried  and  co- 
vered them. 

In  this  case  there  existed  two  injurious  circumstances  of  dif- 
ferent kinds;  one  the  violent  and  continued  action  of  the  muscles, 
which  destroys  by  exhausting  the  sensorial  powTer;  and  the  other, 
the  application  of  cold,  which  destroys  by  defect  of  stimulus. 
The  cold  seems  to  have  contributed  to  the  paralysis  by  its  long 
application,  as  well  as  the  continued  exertion;  but  as  during  the 
torpor  occasioned  by  the  exposure  to  cold,  if  the  degree  of  it  be 
not  so  great  as  to  extinguish  life,  the  sensorial  pow'er  becomes 
accumulated;  there  is  reason  to  believe,  that  the  exposing  a pa- 
ralytic limb  to  the  cold  for  a certain  time.,  as  by  covering  it  with 


334 


DISEASES 


Glass  III.  2. 1.  5. 


snow  or  iced  water  for  a few  minutes,  and  then  covering  it 
with  warm  flannel,  and  this  frequently  repeated,  might,  by  ac- 
cumulation of  sensorial  power,  contribute  to  restore  it  to  a state 
of  voluntary  excitability.  As  this  accumulation  of  sensorial 
power,  and  consequent  glow,  seem,  in  the  present  case,  several 
times  to  have  contributed  to  restore  the  numbness  or  inability  of 
those  muscles,  which  at  length  became  paralytic.  See  Class  I. 
2.3.21. 

M.  M.  Ether  externally.  Friction.  Saline  warm  bath. 
Electricity.  Mercurial  ointment.  See  Class  I.  2.  4.  8. 

5.  Raucedo  paralytica.  Paralytic  hoarseness  consists  in  the 
almost  total  loss  of  voice,  which  sometimes  continues  for  months, 
or  even  years,  and  is  occasioned  by  inability  or  paralysis  of  the 
recurrent  nerves  which  serve  the  muscles  of  vocality,  by  open- 
ing or  closing  the  larynx.  The  voice  generally  returns  suddenly, 
even  so  as  to  alarm  the  patient.  A young  lady,  who  had  many 
months  been  affected  with  almost  a total  loss  of  voice,  and  had 
in  vain  tried  variety  of  advice,  recovered  her  voice  in  an  instant, 
on  some  alarm  as  she  was  dancing  at  an  assembly.  Was  this 
owing  to  a greater  exertion  of  volition  than  usual?  like  the 
dumb  young  man,  the  son  of  Croesus,  who  is  related  to  have 
cried  out,  when  he  saw  his  father’s  life  endangered  by  the  sword  of 
his  enemy,  and  to  have  continued  to  speak  ever  afterwards.  Two 
young  ladies  in  this  complaint  seemed  to  be  cured  by  electric 
shocks  passed  through  the  larynx  every  day  for  a fortnight.  See 
Raucedo  catarrhalis,  Class  II.  1.  3.  5. 

M.  M.  An  emetic.  Electric  shocks.  Mustard-seed,  a large 
spoonful  swallowed  whole,  or  a little  bruised,  every  morning. 
Valerian.  Burnt  sponge.  Blisters  on  each  side  of  the  larynx. 
Sea-bathing.  A gargle  of  decoction  of  seneca.  Friction.  Fre- 
quent endeavours  to  shout  and  sing. 

6.  Visicai  urinaria  paralysis.  Paralysis  of  the  bladder  is  fre- 
quently a symptom  in  irritative  fever;  in  this  case  the  patient 
makes  no  water  for  a day  or  two;  and  the  tumour  of  the  blad- 
der distended  with  urine  may  be  seen  by  the  shape  of  the  abdo- 
men, as  if  girt  by  a chord  below  the  navel,  or  distinguished  by 
the  hand.  Many  patients  in  this  situation  make  no  complaint, 
and  suffer  great  injury  by  the  inattention  of  their  attendants; 
the  water  must  be  drawn  off  once  or  twice  a day  by  means  of  a 
catheter,  and  the  region  of  the  bladder  gently  pressed  by  the 
hand,  whilst  the  patient  is  kept  in  a sitting  or  erect  posture.  See 
Class  II.  2.  2.  6. 

M.  M.  Bark.  Wine.  Opium,  a quarter  of  a grain  ever)' six 
hours.  Balsam  of  copaiva  or  of  Peru.  Tincture  of  cantharides 
20  drops  twice  a day,  or  repeated  small  blisters. 


Class  III.  2. 1.  7. 


OF  VOLITION. 


335 


An  inability  to  empty  the  bladder  frequently  occurs  to  elderly 
men,  and  is  often  fatal.  This  sometimes  arises  from  their 
having  too  long  been  restrained  from  making  water  from  acci- 
dental confinement  in  public  society,  or  otherwise;  whence  the 
bladder  has  become  so  far  distended  as  to  become  paralytic;  and 
not  only  this,  but  the  neck  of  the  bladder  has  become  contracted 
so  as  to  resist  the  introduction  of  the  catheter.  In  this  deplora- 
ble case  it  has  frequently  happened,  that  the  forcible  efforts  to 
introduce  the  catheter  have  perforated  the.  urethra;  and  the  in- 
strument has  been  supposed  to  pass  into  the  bladder,  when  it  has 
only  passed  into  the  cellular  membrane  along  the  side  of  it;  of 
which  I believe  I have  seen  two  or  three  instances;  and  afterwards 
the  part  has  become  so  much  inflamed  as  to  render  the  introduc- 
tion of  the  catheter  into  the  bladder  impracticable. 

In  this  situation  the  patients  are  in  imminent  danger,  and  some 
have  advised  a trocar  to  be  introduced  into  the  bladder  from  the 
rectum;  which  I believe  is  generally  followed  by  an  incurable 
ulcer.  One  patient  whom  l saw  in  this  situation,  began  to  make 
a spoonful  of  water  after  six  or  seven  days,  and  gradually  in  a 
few  days  emptied  his  bladder  to  about  half  its  size,  and  re- 
covered; but  I believe  he  never  afterwards  was  able  completely 
to  evacuate  it. 

In  this  situation  I lately  advised  about  two  pounds  of  crude 
quicksilver  to  be  poured  down  a glass  tube,  which  was  part  of  a 
barometer  tube,  drawn  less  at  one  end,  and  about  two  feet  long, 
into  the  urethra,  as  the  patient  lay  on  his  back;  which  I had 
previously  performed  upon  a horse;  this  easily  passed,  as  was 
supposed,  into  the  bladder;  on  standing  erect  it  did  not  return, 
but  on  kneeling  down,  and  lying  horizontally  on  his  bands,  the 
mercury  readily  returned;  and  on  this  account  it  was  believed 
to  have  passed  into  the  bladder,  as  it  so  easily  returned,  when  the 
neck  of  the  bladder  was  lower  than  the  fundus  of  it.  But  never- 
theless as  no  urine  followed  the  mercury,  though  the  bladder 
was  violently  distended,  I was  led  to  believe,  that  the  urethra 
had  been  perforated  by  the  previous  efforts  to  introduce  a cathe- 
ter and  bougie;  and  that  the  mercury  had  passed  on  the  outside 
of  the  bladder  into  the  cellular  membrane. 

As  the  urethra  is  so  liable  to  be  perforated  by  the  forcible  ef- 
forts to  introduce  the  catheter,  when  the  bladder  is  violently  dis- 
tended in  this  deplorable  disease,  I should  strongly  recommend 
the  injection  of  a pound  or  two  of  crude  mercury  into  the  ure- 
thra, to  open  by  its  weight  the  neck  of  the  bladder  previous  to 
any  violent  or  very  frequent  essays  with  a catheter,  whether  of 
metal  or  of  elastic  resin. 

Recti  paralysis.  Palsy  of  the  rectum.  The  rectum  intes- 


336 


DISEASES 


Class  III  2 1.  8. 


tinum,  like  the  urinary  bladder  in  the  preceding  article,  possesses 
voluntary  power  of  motion;  though  these  volitions  are  at  times 
uncontrollable  by  the  will,  when  ihe  acrimony  of  the  contained 
feces,  or  their  bulk,  stimulates  it  to  a greater  degree.  Hence  it 
happens,  that  this  part  is  liable  to  lose  its  voluntary  power  by 
paralysis,  but  is  still  liable  to  be  stimulated  into  action  by  the 
contained  feces.  This  frequently  occurs  in  fevers,  and  is  a bad 
sign  as  a sympton  of  general  debility;  and  it  is  the  sensibility  of 
the  muscular  fibres  of  this  and  of  the  urinary  bladder  remaining, 
after  the  voluntarity  has  ceased,  which  occasions  these  two  re- 
servoirs so  soon  to  regain,  as  the  fever  ceases,  their  obedience  to 
volition;  because  the  paralysis  is  thus  shewn  to  be  less  complete 
in  those  cases  than  in  common  hemiplegia;  as  in  the  latter  the 
sense  of  touch,  though  perhaps  not  the  sense  of  pain,  is  gene- 
rally destroyed  in  the  paralytic  limb. 

M.  M.  A sponge  introduced  within  the  sphincter  ani  to  pre- 
vent the  constant  discharge,  which  should  have  a string  put 
through  it,  by  which  it  may  be  retracted. 

8.  Paresis  voluntaria.  Indolence:  or  inaptitude  to  voluntary 
action.  This  debility  of  the  exertion  of  voluntary  efforts  pre- 
vents the  accomplishment  of  all  great  events  in  life.  It  often 
originates  from  a mistaken  education,  in  which  pleasure  or  flat- 
tery is  made  the  immediate  motive  of  action,  and  not  future  ad- 
vantage; or  what  is  termed  duty.  This  observation  is  of  great 
value  to  those,  who  attend  to  the  education  of  their  own  chil- 
dren. I have  seen  one  or  two  young  married  ladies  of  fortune 
who  perpetually  became  uneasy,  and  believed  themselves  ill,  a 
week  after  their  arrival  in  the  country,  and  continued  so  uniform- 
ly during  their  stay;  yet  on  their  return  to  London  or  Bath,  im- 
mediately lost  all  their  complaints,  and  this  repeatedly;  which  I 
was  led  to  ascribe  to  their  being  in  their  infancy  surrounded  with 
menial  attendants,  who  had  flattered  them  into  the  exertions 
they  then  used.  And  that  in  their  riper  years,  they  became  tor- 
pid for  want  of  this  stimulus,  and  could  not  amuse  themselves 
by  any  voluntary  employment;  but  required  ever  after,  either 
to  be  amused  by  other  people,  or  to  be  flattered  into  activity. 
This  I suppose,  in  the  other  sex,  to  have  supplied  one  source  of 
ennui  and  suicide.  See  Class  III.  1.2.  11. 

9.  Caialepsis  is  sometimes  used  for  fixed  or  spasmodic  contrac- 
tions, or  tetanus,  as  described  in  Sect.  XXXIV  .1.5.  and  in  Class 
III.  1.  1.  13.  but  is  properly  simply  an  inaptitude  to  muscular 
motion,  the  limbs  remaining  in  any  attitude  in  which  they  are 
placed.  One  patient  whom  I saw  in  this  situation,  had  taken 
much  mercury,  and  appeared  universally  torpid.  He  sat  in  a 
chair  in  any  posture  he  was  put,  and  held  a glass  to  his  mouth 


Cjuss  III.  2. 1.  10. 


OF  VOLITION. 


337 


for  many  minutes  without  attempting  to  drink,  or  withdrawing 
his  hand.  He  never  spoke,  and  it  was  at  first  necessary  to 
compel  him  to  drink  broth;  he  recovered  in  a few  weeks  with- 
out relapse. 

10.  Hemiplegia.  Palsy  of  one  side  consists  in  the  total  dis- 
obedience of  the  affected  muscles  to  the  power  of  volition.  As 
the  voluntary  motions  are  not  perpetually  exerted,  there  is  little 
sensorial  power  accumulated  during  their  quiescence,  whence 
they  are  less  liable  to  recover  from  torpor,,  and  are  thus  more 
frequently  left  paralytic,  or  disobedient  to  the  power  of  volition, 
though  they  are  sometimes  still  alive  to  painful  sensation,  as  to 
the  prick  of  a pin,  and  to  heat;  also  to  irritation,  as  in  stretch- 
ing and  yawning;  or  to  electric  shocks.  Where  the  paralysis 
is  complete,  the  patient  seems  gradually  to  learn  to  use  his  limbs 
over  again  by  repeated  efforts,  as  in  infancy;  and,  as  time  is  re- 
quired for  this  purpose,  it  becomes  difficult  to  know,  whether 
the  cure  is  owing  to  the  effect  of  medicines,  or  to  the  repeated 
eflorts  of  the  voluntary  power. 

The  dispute,  whether  the  nerves  decussate  or  cross  each  other 
before  they  leave  the  cavities  of  the  skull  or  spine,  seems  to  be 
decided  in  the  affirmative  by  comparative  anatomy;  as  the  op- 
tic nerves  of  some  fish  have  been  shewn  evidently  to  cross  each 
other;  as  seen  by  Haller,  Elm.  Physiol,  t.  v.  p.  349.  Hence 
the  application  of  blisters  or  of  ether,  or  of  warm  fomentations, 
should  be  on  the  side  of  the  head  opposite  to  that  of  the  affected 
muscles.  This  subject  should  nevertheless  be  nicely  determin- 
ed, before  any  one  should  trepan  for  the  hydrocephalus  inter- 
nus,  when  the  disease  is  shewn  to  exist  only  on  one  side  of  the 
brain,  by  a squinting  affecting  but  one  eye;  as  proposed  in 
Class  I.  2,  5.  4.  Dr.  Sommering  has  shewrn,  that  a true  decus- 
sation of  the  optic  nerves  in  the  human  subject  actually  exists, 
Elem.  of  Physiology  by  Blumenbach,  translated  by  C.  Caldwell, 
Philadelphia.  This  further  appears  probable  from  the  oblique 
direction  and  insertion  of  each  optic  nerve,  into  the  side  of  the 
eye  next  to  the  nose,  in  a direct  line  from  the  opposite  side  of 
the  brain. 

The  vomiting,  which  generally  attends  the  attack  of  hemiple- 
gia, is  mentioned  in  Sect.  XX.  8.  and  is  similar  to  that  attend- 
ing vertigo  in  sea-sickness,  and  at  the  commencement  of  some 
fevers.  Black  stools  sometimes  attend  the  commencement  of 
hemiplegia,  which  is  probably  an  effusion  of  blood  from  the 
biliary  duct,  where  the  liver  is  previously  affected;  or  some  blood 
may  be  derived  to  the  intestines  by  its  escaping  from  the  vena 
cava  into  the  receptacle  of  chyle  during  the  distress  of  the  para- 
lytic attack;  and  may  be  conveyed  from  thence  into  the  intes- 

VOF,  II.  x x 


3d8 


DISEASES 


Class  III.  2. 1.  10 


tines  by  the  retrograde  motions  of  the  lacteals;  as  probably 
sometimes  happens  in  diabetes.  See  Sect.  XXVII.  2.  Palsy  of 
one  side  of  the  face  is  mentioned  in  Class  II.  1.4  6.  Paralysis 
of  the  lacteals,  of  the  liver,  and  of  the  veins,  which  are  describ- 
ed in  Sect.  XXVIII.  XXX.  and  XX\  II.  do  not  belong  to  this 
class,  as  they  are  not  diseases  of  voluntary  motions. 

M.  M.  The  electric  sparks  and  shocks,  if  used  early  in  the 
disease,  are  frequently  of  service.  A purge  of  aloes,  or  calo- 
mel. A vomit.  Blister.  Saline  draughts.  Then  the  bark. 
Mercurial  ointment  or  sublimate,  where  the  liver  is  evidently 
diseased;  or  where  the  gutta  rosea  has  previously  existed.  Sud- 
den alarm.  Frequent  voluntary  efforts.  Externally  ether. 
Volatile  alkali.  Fomentation  on  the  head.  Friction.  When 
children,  who  have  suffered  a hemiplegia,  begin  to  use  the  af- 
fected arm,  the  other  hand  should  be  tied  up  for  half  an  hour 
three  or  four  limes  a day;  which  obliges  them  at  their  play  to 
use  more  frequent  voluntary  efforts  with  the  diseased  limb,  and 
thus  sooner  to  restore  the  dissevered  associations  of  motion. 

In  hemiplegia,  as  well  as  toward  the  end  of  some  fevers  with 
great  debility,  the  parts  about  the  loins  are  liable  to  mortify  by 
the  pressure  of  a continued  recumbency  upon  them,  and  in  part 
bv  the  friction  of  those  parts  against  the  sheet,  as  the  patient 
slides  down  again  after  being  frequently  raised  higher  in  his  bed. 
to  prevent  which  a pillow  should  be  put  beneath  the  under- 
sheet half  way  down  the  bed,  as  in  Class  II.  1.2.  4.  A solu- 
tion of  sugar  of  lead,  or  white  lead  in  fine  powder,  or  a cerate 
of  lapis  calaminaris,  contributes  to  heal  or  to  prevent  these  ex- 
coriations. But  the  most  efficacious  preventive  consists  in  the 
patient’s  wearing  a pair  of  linen  drawers;  by  which  means, 
when  he  slides  down  in  his  bed,  the  friction  will  be  between  the 
sheet  and  his  drawers,  not  between  the  sheet  and  his  skin;  and 
this  greater  friction  will  in  general  prevent  his  sliding  down  in 
bed,  when  his  head  and  shoulders  are  raised  on  more  piilows, 
which  will  on  this  account  also  contribute  much  to  his  comfort; 
this  is  also  worthy  the  attention  of  those  dropsical  patients,  who 
are  necessitated  to  lie  with  the  head  raised  high  in  bed. 

When  these  patients  have  any  difficulty  of  swallowing,  they 
should  be  raised  up  when  any  fluid  is  put  into  the  mouth,  lest  it 
should  suffocate  them.  See  Apoplexia,  No.  16.  Nor  should 
young  children  be  fed  as  they  lie  on  their  backs,  as  they  are 
then  obliged  to  swallow  as  much  as  the  nurse  pleases;  like  one 
of  the  punishments  formerly  used  in  the  inquisition,  where  the 
delinquent  was  made  to  swallow  many  quarts  of  waier,  as  he 
was  chained  down  on  his  back,  and  was  suffocated  by  it. 

In  paralysis  of  the  wrists  from  lead,  Mr.  Clutterbuck  has  lately 


Class  III.  2.  1.  11. 


OP  VOLITION. 


339 


published  some  successful  cases  of  the  use  of  mercurial  oint- 
ment. See  Colica  Saturnina,  I.  2.  4.  8.  See  Class  III.  2.  1.4. 

Dr.  J.  Alderson  has  lately  much  recommended  the  leaves  of 
rhus  toxicodendron  (sumach,)  from  i.  gr.  to  iv.  of  the  dried 
powder  to  be  taken  three  or  four  times  a day.  Essay  on  Rhus 
Toxic.  Johnson,  London,  1793.  But  it  is  difficult  to  know 
what  medicine  is  of  service,  as  the  movements  of  the  muscles 
must  again  be  learned,  as  in  infancy,  by  frequent  efforts. 

11.  Paraplegia.  A palsy  of  the  lower  half  of  the  body  divid- 
ed horizontally.  Animals  may  be  conceived  to  have  double  bo- 
dies, one  half  in  general  resembling  so  exactly  the  other,  and 
being  supplied  with  separate  sets  of  nerves;  this  gives  rise  to 
hemiplegia,  or  palsy  of  one  half  of  the  body  divided  vertically; 
but  the  paraplegia,  or  palsy  of  the  lower  parts  of  the  system, 
depends  on  an  injury  of  the  spinal  marrow,  or  that  part  of  the 
brain  which  is  contained  in  the  vertebras  of  the  back;  by  which 
all  the  nerves  situated  below  the  injured  part  are  deprived  of 
their  nutriment,  or  precluded  from  doing  their  proper  offices;  and 
the  muscles,  to  which  they  are  derived,  are  in  consequence  dis- 
obedient to  the  power  of  volition. 

This  sometimes  occurs  from  an  external  injury,  as  a fall  from 
an  eminence;  of  which  I saw  a deplorable  instance,  where  the 
bladder  and  rectum,  as  well  as  the  lowrer  limbs,  were  deprived  of 
so  much  of  their  powers  of  motion,  as  depended  on  volition  or 
sensation;  but  I suppose  not  of  that  part  of  it,  which  depends  on 
irritation.  In  the  same  manner  as  the  voluntary  muscles  in  hemi- 
plegia are  sometimes  brought  into  action  by  irritation,  as  in 
stretching  or  pandiculation,  described  in  Sect.  VII.  1.  3. 

But  the  most  frequent  cause  of  paraplegia  is  from  a protuber- 
ance of  one  of  the  spinal  vertebras;  which  is  owing  to  the  innu- 
trition or  softness  of  bones,  described  in  Class  I.  2.  2.  17. 
The  cure  of  this  deplorable  disease  is  frequently  affected  by  the 
stimulus  of  an  issue  placed  on  each  side  of  the  prominent  spine, 
as  first  published  by  Mr.  Pott.  The  other  means  recommended 
in  softness  of  bones  should  also  be  attended  to;  both  in  respect 
to  the  internal  medicines,  and  to  the  mechanical  methods  of  sup- 
porting, or  extending  the  spine;  which  last,  however,  in  this  case 
requires  particular  caution. 

12.  Somnus.  In  sleep  all  voluntary  power  is  suspended,  see 
Sect.  XVIII.  An  unusual  quantity  of  sleep  is  often  produced 
by  weakness.  In  this  case  small  doses  of  opium,  wine,  and 
bark,  may  be  given  with  advantage.  For  the  periods  of  sleep, 
see  Class  IV.  2.  4.  1. 

The  subsequent  ingenious  observations  on  the  frequency  of 


340 


DISEASES 


Class  III.  2.  1.  12. 


the  pulse  which  sometimes  occurs  iu  sleep,  are  copied  from  a 
letter  of  Dr.  Currie  of  Liverpool  to  the  author. 

u Though  rest  in  general  perhaps  renders  the  healthy  pulse 
slower,  yet  under  certain  circumstances  the  contrary  is  the  truth. 
A full  meal,  without  wine  or  other  strong  liquor  does  not  in- 
crease the  frequency  of  my  pulse,  while  I sit  upright,  and  have 
my  attention  engaged.  But  if  1 take  a recumbent  posture  af- 
ter eating,  my  pulse  becomes  more  frequent,  especially  if  my 
mind  be  vacant,  and  I become  drowsy;  and,  if  I slumber, 
this  increased  frequency  is  more  considerable  with  heat  and 
flushing. 

“ This  I apprehend  to  be  a general  truth.  The  observation 
may  be  frequently  made  upon  children;  and  the  restless  and  fe- 
verish nights  experienced  by  many  people  after  a full  supper  are, 
I believe,  owing  to  this  cause.  The  supper  occasions  no  incon- 
venience whilst  the  person  is  upright  and  awake;  but,  when  he 
lies  down  and  begins  to  sleep,  especially  if  he  does  not  perspire 
the  symptoms  above  mentioned  occur.  Which  may  be  thus  ex- 
plained in  part  from  your  principles.  When  the  power  of  voli- 
tion is  abolished,  the  other  sensorial  actions  are  increased.  In 
ordinary  sleep  this  does  not  occasion  increased  frequency  of  the 
pulse;  but  where  sleep  takes  place  during  the  process  of  diges- 
tion, the  digestion  itself  goes  on  with  increased  rapidity.  Heat 
is  excited  in  the  system  faster  than  it  is  expended;  and  operating 
on  the  sensitive  actions,  it  carries  them  beyond  the  limitation  of 
pleasure,  producing,  as  is  common  in  such  cases,  increased  fre- 
quency of  pulse. 

“ It  is  to  be  observed,  that  in  speaking  of  the  heat  generated 
under  these  circumstances,  Ido  not  allude  to  any  chemical  evolu- 
tion of  heat  from  the  food  in  the  process  of  digestion.  I doubt 
if  this  takes  place  to  any  considerable  degree,  for  I do  not  observe 
that  the  parts  incumbent  on  the  stomach  are  increased  in  heat 
during  the  most  hurried  digestion.  It  is  on  some  parts  of  the  sur- 
face, but  more  particularly  on  the  extremities  of  the  body,  that 
the  increased  heat  excited  by  digestion  appears,  and  the  heat  thus 
produced  arises,  as  it  should  seem,  from  the  sympathy  be- 
tween the  stomach  and  the  vessels  of  the  skin.  The  parts 
most  affected  are  the  palms  of  the  hands,  and  the  soles  of  the  feet. 
Even  there  the  thermometer  seldom  rises  above  97  or  98  degrees, 
a temperature  not  higher  than  that  of  the  trunk  of  the  body: 
but  three  or  four  degrees  higher  than  the  common  temperature 
of  these  parts,  and  therefore  producing  an  uneasy  sensation  of 
heat,  a sensation  increased  by  the  great  sensibility  of  the  parts 
affected. 

“ That  the  increased  heal  excited  by  digestion  in  sleep  is  the 


Class  TIT,  2. 1.  12. 


OF  VOLITION. 


341 


cause  of  the  accompanying  fever,  seems  to  be  confirmed  by  ob- 
serving, that  if  an  increased  expenditure  of  heat  accompanies  the 
increased  generation  of  it,  (as  when  perspiration  on  the  extremi- 
ties or  surface  attends  this  kind  of  sleep)  the  frequent  pulse  and 
flushed  countenance  do  not  occur,  as  I know  by  experiment.  If, 
during  the  feverish  sleep  already  mentioned,  I am  awakened,  and 
my  attention  engaged  powerfully,  my  pulse  becomes  almost  im- 
mediately slower,  and  the  fever  gradually  subsides.” 

From  these  observation*  of  Dr.  Currie  it  appears,  that,  while 
in  common  sleep  the  actions  of  the  heart,  arteries,  and  capillaries, 
are  strengthened  by  the  accumulation  of  sensorial  power  during 
the  suspension  of  voluntary  action,  and  the  pulse  in  consequence 
becomes  fuller  and  slower;  in  the  feverish  sleep  above  described, 
the  actions  of  the  heart,  arteries,  and  capillaries,  are  quickened 
as  well  as  strengthened  by  their  consent  with  the  increased  ac- 
tions of  the  stomach,  as  well  as  by  the  stimulus  of  the  new  chyle 
introduced  into  the  circulation.  For  the  stomach,  and  all  other 
parts  of  the  system,  being  more  sensible  and  more  irritable  during 
sleep,  Sect.  XVIII.  15.  and  probably  more  ready  to  act  from  as- 
sociation, are  now  exerted  with  greater  velocity  as  well  as  strength, 
constituting  a temporary  fever  of  the  sensitive  irritated  kind,  re- 
sembling the  fever  excited  by  wine  in  the  beginning  of  intoxica- 
tion; or  in  some  people  by  a full  meal  in  their  waking  hours. 
Sect.  XXXV.  1. 

On  waking,  this  increased  sensibility  and  irritability  of  the 
system  cease,  by  the  renewed  exertions  of  volition;  in  the  same 
manner  as  more  violent  exertions  of  volition  destroy  greater  pains; 
and  the  pulse  in  consequence  subsides  along  with  the  increase  of 
heat;  if  more  violent  efforts  of  volition  are  exerted,  the  system  be- 
comes still  less  affected  by  sensation  or  irritation.  Hence  the 
fever  and  vertigo  of  intoxication  are  lessened  by  intense  thinking, 
Sect.  XXI.  8.;  and  insane  people  are  known  to  bear  the  pain  of 
cold  and  hunger  better  than  others,  Sect.  XXXIV.  2.  5.;  and 
lastly,  if  greater  voluntary  efforts  exist,  as  in  violent  anger  or  vi- 
olent exercise,  the  whole  system  is  thrown  into  more  energetic  ac- 
tion, and  a voluntary  fever  is  induced,  as  appears  by  the  red  skin, 
quickened  pulse,  and  increase  of  heat;  whence  dropsies  and  fe- 
vers with  debility  are  not  unfrequently  removed  by  insanity. 

Hence  the  exertion  of  the  voluntary  power  in  its  natural  de- 
gree diminishes  the  increased  sensibility,  and  irritability,  and 
probably  the  increased  associability,  which  occur  during  sleep; 
and  thus  reduces  the  frequency  of  the  pulse  in  the  feverish  sleep 
after  a full  meal.  In  its  more  powerful  state  of  exertion,  it  di- 
minishes or  destroys  sensations  and  irritations,  which  are  stronger 


342 


DISEASES 


Class  II  r.  2. 1. 1J. 


than  natural,  as  in  intoxication,  or  which  precede  convulsions,  or 
insanity.  In  its  still  more  powerful  degree,  the  superabundance 
of  this  sensorial  power  actuates  and  invigorates  the  whole  moving 
system,  giving  strength  and  frequency  to  the  pulse,  and  an  uni- 
versal glow  both  of  colour  and  of  heat,  as  in  violent  anger,  or  out- 
rageous insanities. 

If,  in  the  feverish  sleep  above  described,  the  skin  becomes 
cooled  by  the  evaporation  of  much  perspirable  ma.ter,  or  by  the 
application  of  cooler  air,  or  thinner  clothes,  the  actions  of  the 
cutaneous  capillaries  are  lessened  by  defect  of  the  stimulus  of 
heat,  which  counteracts  the  increase  of  sensibility  during  sleep, 
and  the  pulsations  of  the  heart  and  arteries  become  slower  from 
the  lessened  stimulus  of  the  particles  of  blood  thus  cooled  in  the 
cutaneous  and  pulmonary  vessels.  Hence  the  admission  of  cold 
air,  or  ablution  with  subtepid  or  with  cold  water,  in  fevers  with 
hot  skin,  whether  they  be  attended  with  arterial  strength,  or  ar- 
terial debility,  renders  the  pulse  slower;  in  the  former  case  by 
diminishing  the  stimulus  of  the  blood,  and  in  the  latter  by  less- 
ening the  expenditure  of  sensorial  power.  See  Suppl.  I.  8. 
and  lo. 

13.  Incubus.  The  night-mare  is  an  imperfect  sleep,  where 
the  desire  of  locomotion  is  vehement,  but  the  muscles  do  not 
obey  the  will;  it  is  attended  with  great  uneasiness,  a sense  of 
suffocation,  and  frequently  with  fear.  It  is  caused  by  violent 
fatigue,  or  drunkenness,  or  indigestible  food,  or  lying  on  the  back, 
or  perhaps  from  many  other  kinds  of  uneasiness  in  our  sleep, 
which  may  originate  either  from  the  body  or  mind. 

Now  as  the  action  of  respiration  is  partly  voluntary,  this  com- 
plaint may  be  owing  to  the  irritability  of  the  system  being  too 
small  to  carry  on  the  circulation  of  the  blood  through  the  lungs 
during  sleep,  when  the  voluntary  power  is  suspended.  hence 
the  blood  may  accumulate  in  them,  and  a painful  oppression  su- 
pervene; as  in  some  haemorrhages  of  the  lungs,  which  occur  dur- 
ing sleep;  and  in  patients  much  debilitated  by  fevers.  See  Som- 
nus  interruptus,  Class  I.  2.  1.  3.  and  1.  2.  1.  9. 

Great  fatigue  with  a full  supper  and  much  wine,  I have  been 
well  informed  by  one  patient,  always  produced  this  disease  in 
himself  to  a great  degree.  Now  the  general  irritability  ot  the 
system  is  much  decreased  by  fatigue,  as  it  exhausts  the  sensorial 
power;  and  secondly,  too  much  wine  and  stimulating  food  will 
again  diminish  the  irritability  of  some  parts  of  the  system,  by  em- 
ploying a part  of  the  sensorial  power,  which  is  already  too  small, 
in  digesting  a great  quantity  of  aliment;  and  in  increasing  the 
motions  of  the  organs  of  sense  in  consequence  of  some  de- 


OF  VOLITION. 


Class  III.  2.  1. 14. 


343 


gree  of  intoxication,  whence  difficulty  of  breathing  may  occur  from 
the  inirritability  of  the  lungs,  as  in  Class  I.  2.  1.  3. 

This  explains  an  apparent  paradox,  why  people  who  are  feeble, 
digest  their  dinners  best,  if  they  lie  down  and  sleep,  as  most 
animals  do,  when  their  stomachs  are  full.  Yet  many  weak  peo- 
ple sleep  very  uneasily  after  a large  supper.  If  the  debility  of  the 
patient  be  not  very  great,  and  the  dinner  he  has  taken  be  mode- 
rate, the  suspension  of  voluntary  action  during  sleep  prevents  the 
expenditure  of  so  much  sensorial  power,  which  may  be  employed 
on  the  actions  of  the  stomach,  and  thus  facilitate  the  digestive 
process.  If  the  patient  be  further  exhausted  as  in  the  evening, 
or  his  debility  greater,  and  sleep  ensues  after  a copious  or  stimu- 
lating supper,  so  much  sensorial  power  will  be  exerted  on  the  ac- 
tions of  the  stomach  for  digestion,  that  the  circulation  of  the  blood 
through  the  lungs  will  be  impeded  from  the  diminished  irritability 
to  external  stimuli,  and  the  absence  of  volition,  as  in  the  incubus, 
and  somnus  interruptus. 

M.  M.  To  sleep  on  a hard  bed  with  the  head  raised.  Moderate 
supper.  The  bark.  By  sleeping  on  a harder  bed  the  patient  will 
turn  himself  more  frequently,  and  not  be  liable  to  sleep  too  pro- 
foundly, or  lie  too  long  in  one  posture.  To  be  awakened  fre- 
quently by  an  alarm  clock. 

14.  Lethargus.  The  lethargy  is  a slighter  apoplexy.  It  is 
supposed  to  originate  from  universal  pressure  on  the  brain,  and  is 
said  to  be  produced  by  compressing  the  spinal  marrow,  where 
there  is  a deficiency  of  the  bone  in  the  spina  bifida.  See  Sect. 
XVIII.  20.  Whereas  in  the  hydrocephalus  there  is  only  a partial 
pressure  of  the  brain:  and  probably  in  nervous  fevers  with  stupor 
the  pressure  on  the  brain  may  affect  only  the  nerves  of  the  senses, 
which  lie  within  the  skull,  and  not  those  nerves  of  the  medulla 
oblongata,  which  principally  contribute  to  move  the  heart  and 
arteries;  whence  in  the  lethargic  or  apoplectic  stupor  the  pulse  is 
slow  as  in  sleep,  whereas  in  nervous  fever  the  pulse  is  very  quick 
and  feeble,  and  generally  so  in  hydrocephalus. 

In  cases  of  obstructed  kidneys,  whether  owing  to  the  tubuli 
uriniferi  being  totally  obstructed  by  calculous  matter,  or  by 
their  paralysis,  a kind  of  drowsiness  or  lethargy  comes  on  about 
the  eighth  or  ninth  day,  and  the  patient  gradually  sinks.  See 
Class  I.  1.  3.  9. 

15.  Syncope  epileptica,  is  a temporary  apoplexy,  the  pulse  con- 
tinuing in  its  natural  state,  and  the  voluntary  power  suspended. 
This  terminates  the  paroxysms  of  epilepsy. 

When  the  animal  power  is  much  exhausted  by  the  preced- 
ing convulsions,  so  that  the  motions  from  sensation  as  well  as 
those  from  volition  are  suspended;  in  a quarter  or  half  an  hour 


344 


DISEASES 


Class  ILF.  2 1.  16. 


the  sensorial  power  becomes  restored,  and  if  no  pain,  or  irritation 
producing  pain,  recurs,  the  fit  of  epilepsy  ceases;  if  the  pain  re- 
curs, or  the  irritation,  which  used  to  produce  it,  a new  fit  of  con- 
vulsion takes  place,  and  is  succeeded  again  by  a syncope.  See 
Epilepsy,  Class  III.  1.  1.  7. 

16.  Apoplexia.  Apoplexy  may  be  termed  an  universal  palsy, 
or  a permanent  sleep.  In  which,  where  the  pulse  is  weak,  copious 
bleeding  must  be  injurious;  as  is  well  observed  by  Dr.  Heberden. 
Trans,  of  the  College. 

Mr. , about  70  years  of  age,  had  an  apoplectic  seizure. 

His  pulse  was  strong  and  full.  One  of  the  temporal  arteries  was 
opened,  and  about  ten  ounces  of  blood  suddenly  taken  from  it. 
He  seemed  to  receive  no  benefit  from  this  operation;  but  gradually 
sunk,  and  lived  but  a day  or  two. 

If  apoplexy  arises  from  the  pressure  of  blood  extravasated  on 
the  brain,  one  moderate  venesection  may  be  of  service  to  pre- 
vent the  further  effusion  of  blood;  but  copious  venesection  must 
be  injurious  by  weakening  the  patient;  since  the  effused  blood 
must  have  time,  as  in  common  vibices  or  bruises,  to  undergo  a 
ehemico-animal  process,  so  to  change  its  nature  as  to  fit  it  for 
absorption;  which  may  take  two  or  three  weeks,  which  time  a 
patient  weakened  by  repeated  venesection  or  arteriotomy  may 
not  survive. 

Mrs. , about  40  years  old,  had  an  apoplectic  seizure  after 

great  exertion  from  fear;  she  had  lain  about  24  hours  without 
speech,  or  having  swallowed  any  liquid.  She  was  then  forcibly 
raised  in  bed,  and  a spoonful  of  solution  of  aloes  in  wine  put  into 
her  mouth,  and  the  end  of  the  spoon  withdrawn,  that  she  might 
more  easily  swallow  the  liquid.  This  was  done  every  hour,  with 
broth,  and  wine  and  water  intervening,  till  evacuations  were  pro- 
cured; which,  with  other  means,  had  good  effect,  and  she  recover- 
ed, except  that  a considerable  degree  of  hemiplegia  remained, 
and  some  imperfection  of  her  speech. 

Many  people,  who  have  taken  so  much  vinous  spirit  as  to  ac- 
quire the  temporary  apoplexy  of  intoxication,  and  are  not  im- 
properly said  to  be  dead-drunk,  have  died  after  copious  venesec- 
tion, I suppose  in  consequence  of  it.  I once  saw  at  a public 
meeting  two  gentlemen  in  the  drunken  apoplexy;  they  were  to- 
tally insensible  with  low  pulse,  on  this  account  they  were  directed 
not  to  lose  blood,  but  to  be  laid  on  a bed  with  their  heads  high, 
and  to  be  turned  every  half  hour;  as  soon  as  they  could  swallow, 
warm  tea  was  given  them,  which  evacuated  their  stomachs,  and 
they  gradually  recovered,  as  people  do  from  less  degrees  of  in- 
toxication. 

M.  M.  Cupping  on  the  occiput.  Venesection  once  in  mode- 


OP  VOLITION. 


345 


Class  III.  2.  1. 17. 

rate  quantity.  Warm  fomentations  long  continued  and  fre- 
quently repeated  on  the  shaved  head.  Solution  of  aloes.  Clys- 
ters with  solution  of  aloes  and  oil  of  amber.  A blister  on  the 
spine.  An  emetic.  Afterwards  the  bark,  and  small  doses  of 
ehalybeates.  Small  electric  shocks  through  the  head.  Errhines. 
If  small  doses  of  opium?  mercurial  ointment  rubbed  on  the  head 
or  neck? 

Where  there  is  a difficulty  of  swallowing  in  apoplectic  or  para- 
lytic patients,  or  in  those  near  death  in  fevers,  or  other  diseases, 
no  fluid  should  be  put  into  their  mouths  as  they  lie  upon  their 
backs,  lest  it  should  choke  them;  but  they  should  be  raised  and 
supported  .upright  in  their  beds,  and  stimulated  by  strong  light, 
and  spoken  to  in  a louder  voice,  desiring  them  to  swallow,  as  the 
fluid  is  put  into  the  mouth,  and  the  spoon  should  be  immediately 
withdrawn,  that  they  may  close  their  mouths.  Hence  if  they 
cannot  swallow,  it  will  flow  out  of  their  mouths,  and  not  endanger 
suffocating  them.  See  Hemiplegia,  Spec.  10,  of  this  genus. 

17.  Mors  a frigore.  Death  from  cold.  The  unfortunate 
travellers,  who  almost  every  winter  perish  in  the  snow,  are  much 
exhausted  by  their  efforts  to  proceed  on  their  journey,  as  well  as 
benumbed  by  cold.  And  as  much  greater  exercise  can  be  borne 
without  fatigue  in  cold  weather  than  in  warm;  because  the  exces- 
sive motions  of  the  cutaneous  vessels  are  thus  prevented,  and  the 
consequent  waste  of  sensorial  power;  it  may  be  inferred,  that  the 
fatigued  traveller  becomes  paralytic  from  violent  exertion  as  well 
as  by  the  application  of  cold. 

Great  degrees  of  cold  affect  the  motions  of  those  vessels  most, 
which  have  been  generally  excited  into  action  by  irritation;  for 
when  the  feet  are  much  benumbed  by  cold,  and  painful,  and  at 
the  same  time  almost  insensible  to  the  touch  of  external  objects, 
the  voluntary  muscles  retain  their  motions,  and  we  continue  to 
walk  on;  the  same  happens  to  the  fingers  of  children  in  throw- 
ing snow-balls,  the  voluntary  motions  of  the  muscles  continue, 
though  those  of  the  cutaneous  vessels  are  benumbed  into  inac- 
tivity. 

Mr.  Thompson,  an  elderly  gentleman  of  Shrewsbury,  was 
seized  with  hemiplegia  in  the  cold  bath;  which  I suppose  might 
be  owing  to  some  great  energy  of  exertion,  as  much  as  to  the 
coldness  of  the  water.  As  in  the  instance  given  of  Mr.  Nairn, 
who,  by  the  exertion  to  save  his  relation,  perished  himself.  See 
Sect.  XXXIV.  1.  7. 

Whence  I conclude,  that,  though  heat  is  a fluid  necessary  to 
muscular  motion,  both  perhaps  by  its  stimulus,  and  by  its  keep- 
ing the  minute  component  parts  of  the  ultimate  fibrils  of  the 

VOL.  II.  Y y 


346 


DISEASES 


Class  III.  2.  1.  17. 


muscles  or  organs  of  sense  at  a proper  distance  from  each  other; 
yet  paralysis,  properly  so  called,  is  the  consequence  of  exhaus- 
tion of  sensorial  power  by  exertion.  And  that  the  accumulations 
of  it  during  the  torpor  of  the  cutaneous  vessels  by  exposure  to 
cold,  or  of  some  internal  viscus  in  the  cold  fits  of  agues,  are  fre- 
quently instrumental  in  recovering  the  use  of  paralytic  limbs,  or 
of  the  motions  of  other  paralytic  parts  of  the  system.  See  Spec. 
4.  of  this  genus. 

Animal  bodies  resist  the  power  of  cold  probably  by  their  ex- 
ertions in  consequence  of  the  pain  of  cold,  see  Botan.  Card  V. 
1.  additional  note  xii.  But  if  these  increased  exertions  be  too 
violent,  so  as  to  exhaust  the  sensorial  power  in  producing  un- 
necessary motions,  the  animal  will  probably  sooner  perish.  Thus 
a moderate  quantity  of  wine  or  spirit  repeated  at  proper  inter- 
vals of  time  might  be  of  service  to  those,  who  are  long  exposed 
to  excessive  cold,  both  by  increasing  the  action  of  the  capillary 
vessels,  and  thus  producing  heat,  and  perhaps  by  increasing  in 
some  degree  the  secretion  of  sensorial  power  in  the  brain.  But 
the  contrary  must  happen  when  taken  immoderately,  and  not 
at  due  intervals.  A well-attested  history  was  once  related  to 
me  of  two  men,  who  set  out  on  foot  to  travel  in  the  snow,  one 
of  whom  drank  two  or  three  glasses  of  brandy  before  they  began 
their  journey,  the  other  contented  himself  with  his  usual  diet 
and  potation;  the  former  of  whom  perished  in  spite  of  any  as- 
sistance his  companion  could  afford  him;  and  the  other  perform- 
ed his  journey  with  safety.  In  this  case  the  sensorial  power  was 
exhausted  by  the  unnecessary  motions  of  incipient  intoxication 
by  the  stimulus  of  the  brandy,  as  well  as  by  the  exertions  of 
walking;  which  so  weakened  the  dram-drinker,  that  the  cold 
sooner  destroyed  him;  that  is,  he  had  not  power  to  produce  suf- 
ficient muscular  or  arterial  action,  and  in  consequence  sufficient 
heat,  to  supply  the  great  expenditure  of  it.  Hence  the  capilla- 
ries of  the  skin  first  ceased  to  act,  and  became  pale  and  empty; 
next  those  which  are  immediately  associated  with  them,  as  the 
extremities  of  the  pulmonary  artery,  as  happens  on  going  into 
the  cold  bath.  By  the  continued  inaction  of  these  parts  of  the 
vascular  system  the  blood  becomes  accumulated  in  the  internal 
arteries,  and  the  brain  is  supposed  to  be  affected  by  its  compres- 
sion; because  these  patients  are  said  to  sleep,  or  to  become  apo- 
plectic, before  they  die.  I overtook  a fisherman  asleep  on  his 
panniers  on  a very  cold  frosty  night,  but  on  waking  him  he  did 
not  appear  to  be  in  any  degree  of  stupor.  See  Class  I.  2.  2.  1. 

When  travellers  are  benighted  in  deep  snow,  they  might  fre- 
quently be  saved  by  covering  themselves  in  it,  except  a small 
aperture  for  air;  in  which  situation  the  lives  of  hares,  sheep, 


Class  III.  2.  1.  17. 


OP  VOLITION. 


347 


and  other  animals,  are  so  often  preserved.  The  snow,  both  in 
respect  to  its  component  parts,  and  to  the  air  contained  in  its 
pores,  is  a bad  conductor  of  heat,  and  will  therefore  well  keep 
out  the  external  cold;  and  as  the  water,  when  part  of  it  dissolves, 
is  attracted  into  the  pores  of  the  remainder  of  it,  the  situation  of 
an  animal  beneath  it  is  perfectly  dry;  and,  if  he  is  in  contact 
with  the  earth,  he  is  in  a degree  of  heat  between  48,  the  medium 
heat  of  the  earth,  and  32,  the  freezing  point;  that  is,  in  40  de- 
grees of  heat,  in  which  a man  thus  covered  will  be  as  warm  as 
in  bed.  See  Boian.  Garden,  V.  II.  notes  on  Anemone,  Baro- 
metz,  and  Muscus.  If  these  facts  were  more  generally  under- 
stood, it  might  annually  save  the  lives  of  many. 

After  any  part  of  the  vascular  system  of  the  body  has  been 
long  exposed  to  cold,  the  sensorial  power  is  so  much  accumu- 
lated in  it,  that  on  coming  into  a warm  room  the  pain  of  hot- 
ach  is  produced,  and  inflammation,  and  consequent  mortifica- 
tion, owing  to  the  great  exertion  of  those  vessels,  when  again  ex- 
posed to  a moderate  degree  of  warmth.  See  Sect.  XII.  5. 
Whence  the  propriety  of  applying  but  very  low  degrees  of  heat 
to  limbs  benumbed  with  cold  at  first,  as  of  snow  in  its  state  of 
dissolving,  which  is  at  32  degrees  of  heat,  or  of  very  cold  water. 
A French  writer  has  observed,  that  if  frozen  apples  be  thawed 
gradually  by  covering  them  with  thawing  snow,  or  immersing 
them  in  very  cold  water,  they  do  not  lose  their  taste;  if  this 
fact  was  well  ascertained,  it  might  teach  us  how  to  preserve 
other  ripe  fruits  in  ice-houses  for  winter  consumption.  See  Sup. 
I.  14.  3. 

The  pain  of  cold  is  probably  owing  to  the  accumulation  of  the 
sensorial  power  of  irritation.  As  the  skins  of  those,  who  have 
been  constantly  stimulated  into  great  action  by  external  heat, 
must  soon  possess  an  accumulation  of  that  sensorial  power,  when 
the  stimulus  of  heat  is  withdrawn.  See  taedium  vitae  from  ac- 
cumulation of  the  sensorial  power  of  volition.  III.  1.2.  11. 


548 


DISEASES 


Class  III.  2.  2.  1. 


ORDO  II. 

Decreased  Volition. 

GENUS  II. 

With  decreased  Actions  of  the  Organs  of  Sense. 

SPECIES. 

1.  Recollectionis  jactura.  Loss  of  recollection.  This  is  the 
defect  of  memory  in  old  people,  who  forget  the- actions  of  yester- 
day, being  incapable  of  voluntary  recollection,  and  yet  remem- 
ber those  of  their  youth,  which  by  frequent  repetition  are  intro- 
duced by  association  or  suggestion.  This  is  properly  the  paralysis 
of  the  mind;  the  organs  of  sense  do  not  obey  the  voluntary  power: 
that  is,  our  ideas  cannot  be  recollected,  or  acted  over  again  by 
the  will. 

After  an  apoplectic  attack  the  patients,  on  beginning  to  re- 
cover, find  themselves  most  at  a loss  in  recollecting  proper  names 
of  persons  or  places;  as  those  words  have  not  been  so  frequently 
associated  with  the  ideas  they  stand  for,  as  the  commou  words 
of  a language.  Mr. , a man  of  strong  mind,  of  a short- 

necked family,  many  of  whom  had  suffered  by  apoplexy,  after 
an  apoplectic  fit,  on  his  recovering  the  use  of  speech,  after  re- 
peated trials  to  remember  the  name  of  a person  or  place,  ap- 
plauded himself,  when  he  succeeded,  with  such  a childish  smile 
on  the  partial  return  of  his  sagacity,  as  very  much  affected  me. 
Not  long,  alas!  to  return;  for  another  attack  in  a few  weeks  de- 
stroyed the  whole.  See  Class  IV.  2.  3.  8. 

I saw  a child  after  the  small-pox,  which  was  left  in  this  situa-- 
tion;  it  was  lively,  active,  and  even  vigorous;  but  shewed  that 
kind  of  surprise,  which  novelty  excites,  at  every  object  it  viewed: 
and  that  as  often  as  it  viewed  it.  I never  heard  the  termination 
of  the  case. 

2.  Stultitia  voluntaria.  Voluntary  folly.  The  absence  of 
voluntary  power  and  consequent  incapacity  to  compare  the  ideas 
of  present  and  future  good.  Brute  animals  may  be  said  to  be 
in  this  situation,  as  they  are  in  general  excited  into  action  only 
by  their  present  painful  or  pleasurable  sensations.  Hence  though 
they  are  liable  to  surprise,  when  their  passing  trains  of  ideas  are 
dissevered  by  violent  stimuli;  yet  are  they  not  affected  with 
wonder  or  astonishment  at  the  novelty  of  objects,  as  they  pos- 
sess but  in  a very  inferior  degree,  that  voluntary  power  of  com- 


OF  VOLITION. 


349 


Glass  III.  2.  2.  3. 

paring  the  present  ideas  with  those  previously  acquired,  which 
distinguishes  mankind;  and  is  termed  analogical  reasoning, 
when  deliberatively  exerted;  and  intuitive  analogy,  when  used 
without  .our  attention  to  it,  and  which  always  preserves  our 
hourly  trains  of  ideas  consistent  with  truth  and  nature.  See 
Sect.  XVII.  3.  7. 

3.  Ratiocinatio  verbosa.  Verbal  reasoning.  This  arises  from 
the  feeble  or  inaccurate  exertions  of  the  faculty  of  volition  in  the 
act  of  recalling  the  ideas  of  things,  and  thus  mistaking  the  ideas 
of  words  for  them.  One  great  imperfection  of  language  con- 
sists in  the  use  of  what  Mr.  Horne  Tooke  calls  genera!  terms,  as 
mentioned  in  Sect.  XV.  1.  5.  and  Sect.  XVI.  17.  of  this  work, 
and  which  Mr.  Locke  supposed  to  express  abstracted  or  general 
ideas,  such  as  the  word  castle  or  army,  which  in  common  con- 
versation includes  any  part  of  property  of  those  complex  things, 
and  is  thus  liable  to  mislead  inaccurate  thinkers.  Thus  it  was 
said  last  night,  “ That  horse  strikes  fire  as  he  passes  along  the 
pavement.”  And  it  was  added  jocularly,  “ that  his  feet  must 
be  as  hard  as  iron,”  which  mistake  might  arise  from  the  general 
term,  horse,  including  in  common  conversation  both  every  part 
of  the  animal  and  his  accoutrements. 

A second  source  of  false  reasoning  may  arise  from  the  same- 
word  having  two  significations  totally  different  from  each  other; 
which  may  mislead  those  wdio  reason  from  ideas  of  words  in- 
stead of  ideas  of  things.  These  are  generally  esteemed  witti- 
cisms, and  are  called  puns  or  quibbles;  as  the  jocular  syllogism 
on  the  word  spirit.  “ Brandy  is  a spirit;  the  Devil  is  a spirit; 
therefore  brandy  is  the  devil.” 

A third  source  of  false  reasoning  is  derived  from  the  two-fold 
meaning  of  some  sentences,  or  phrases  in  all  languages;  this  is 
also  used  designedly  in  jocular  compositions,  and  constitutes  the 
wit  of  some  comedies.  An  old  miller  riding  on  his  sack  ol 
flour  was  accosted  by  two  young  Cantabs,  wrho  rode  on  each  side 
of  him,  with  “ Gentlemen  of  your  profession  have  sometimes  a 
doubtful  character — pray,  miller,  do  you  think  yourself  more 
knave  or  fool?”  the  witty  miller  answered,  looking  first  at  one 
of  them  and  then  at  the  other,  “ I think  myself  at  present  be- 
tween both.”  This  double  entendre  of  a sentence  was  used  by 
the  priests  of  the  ancient  oracles  to  deceive  the  inquirer  into  fu- 
ture events.  As  that  of 

Aio  te,  JEacide,  Romanos  vincere  posse. 

I say,  that  you,  JEacides,  the  Romans  shall  conquer. 

There  is  a fourth  mode  of  verbose  ratiocination,  which  con- 
sists in  the  conclusion  of  the  syllogism  containing  an  imaginary, 


350 


DISEASES 


Class  III.  2.  2.  4. 


but  not  even  a verbal  analogy  to  the  preceding  propositions. 
Thus  a rustic  devotee  said  to  his  priest,  “ I have  often  wonder- 
ed, why  God  Almighty  called  the  first  man  Adam?”  “ Don’t 
you  know,”  replied  the  teacher,  “ that  A is  the  first  letter  of  the 
alphabet?”  “ Aye,  so  it  is,”  answered  the  contented  inquirer. 

Another  kind  of  false  reasoning  is  called  by  logicians  a logical 
vice;  and  another  kind  arises  from  the  first  proposition  ■ being 
untrue  in  respect  to  its  existence:  but  as  all  these,  and  perhaps 
many  other  sources  of  false  reasonings,  may  be  resolved  into  the 
mistaken  use  of  ideas  of  words,  or  general  terms,  instead  of  ideas 
of  the  things,  or  parts  of  things,  which  they  ought  to  suggest; 
they  belong  properly  to  this  article  of  ratiocinatio  verbosa: 
while  the  rare  faculty  of  reasoning  without  words  by  comparing 
ideas  of  things,  as  in  the  invention  of  new  machines,  and  other 
new  discoveries,  distinguishes  the  philosopher  from  the  sophist. 

M.  M.  Children  should  be  permitted  to  use  their  hands  early 
in  their  infancy,  and  should  be  supplied  with  pencils,  pens,  and 
various  tools;  by  which  they  will  acquire  accurate  ideas  of  ex- 
ternal things  by  the  organ  of  touch,  at  the  same  time  that  they 
acquire  words;  and  will  thence  be  less  liable  to  be  seriously  de- 
ceived by  general  terms,  or  by  the  double  meanings  of  words, 
or  of  sentences,  or  lastly  by  false  propositions  or  inconclusive  de- 
ductions; and  will  thus  be  enabled  to  compare  the  analogies  of 
things,  and  to  think  without  words;  the  faculty,  which  constitutes 
genius,  and  which  so  few  possess! 

4.  Credulitas.  Credulity.  Life  is  short,  opportunities  of 
knowledge  rare;  our  senses  are  fallacious,  our  reasonings  un- 
certain; man  therefore  struggles  with  perpetual  error  from  the 
cradle  to  the  coffin.  He  is  necessitated  to  correct  experiment 
by  analogy,  and  analogy  by  experiment;  and  not  always  to  rest 
satisfied  in  the  belief  of  facts  even  with  this  two-fold  testimony, 
till  future  opportunities,  or  the  observations  of  others,  concur  in 
their  support. 

Ignorance  and  credulity  have  ever  been  companions,  and  have 
misled  and  enslaved  mankind;  philosophy  has  in  all  ages  en- 
deavoured to  oppose  their  progress,  and  to  loosen  the  shackles 
they  had  imposed;  philosophers  have  on  this  account  been  called 
unbelievers:  unbelievers  of  what?  of  the  fictions  of  fancy,  of 
witchcraft,  hobgoblins,  apparitions,  vampires,  fairies;  of  the 
influence  of  stars  on  human  actions,  miracles  wrought  by  the 
bones  of  saints,  the  flights  of  ominous  birds,  the  predictions 
from  the  bowels  of  dying  animals,  expounders  of  dreams,  for- 
tune-tellers, conjurors,  modern  prophets,  necromancy,  cheiro- 
mancy, animal  magnetism,  metallic  tractors,  with  endless  variety 


Class  III.  2.  2 4. 


OF  VOLITION. 


351 


of  folly?  These  they  have  disbelieved  and  despised,  but  have 
ever  bowed  their  hoary  heads  to  Truth  and  Nature. 

Mankind  may  be  divided  in  respect  to  the  facility  of  their  be- 
lief or  conviction  into  two  classes;  those  who  are  ready  to  assent 
to  single  facts  from  the  evidence  of  their  senses,  or  from  the  se- 
rious assertions  of  others;  and  those  who  require  analogy  to  cor- 
roborate or  authenticate  them. 

Our  first  knowledge  is  acquired  by  our  senses;  but  these  are 
liable  to  deceive  us,  and  we  learn  to  detect  these  deceptions  by 
comparing  the  ideas  presented  to  us  by  one  sense  with  those  pre- 
sented by  another.  Thus  when  we  first  view  a cylinder,  it  ap- 
pears to  the  eye  as  a flat  surface  with  different  shades  on  it,  till 
we  correct  this  idea  by  the  sense  of  touch,  and  find  its  surface  to 
be  circular;  that  is,  having  some  parts  gradually  receding  further 
from  the  eye  than  others.  So  when  a child,  or  a cat,  or  a bird, 
first  sees  its  own  image  in  a looking-glass,  it  believes  that  another 
animal  exists  before  it,  and  detects  this  fallacy  by  going  behind 
the  glass  to  examine  if  another  tangible  animal  really  exists  there. 

Another  exuberant  source  of  error  consists  in  the  false  notions 
which  we  receive  in  our  early  years  from  the  design  or  ignorance 
of  our  instructors,  which  affect  all  our  future  reasoning  by  their 
perpetual  intrusions;  as  those  habits  of  muscular  actions  of  the 
face  or  limbs,  which  are  called  tricks,  when  contracted  in  infan- 
cy, continue  to  the  end  of  our  lives. 

A third  great  source  of  error  is  the  vivacity  of  our  ideas  of 
imagination,  which  perpetually  intrude  themselves  by  various 
associations,  and  compose  the  farrago  of  our  dreams;  in  which, 
by  the  suspension  of  volition,  we  are  precluded  from  comparing 
the  ideas  of  one  sense  with  those  of  another,  or  the  incongruity 
of  their  successions  with  the  usual  course  of  nature,  and  thus  to 
detect  their  fallacy.  Which  we  do  in  our  waking  hours  by  a per- 
petual voluntary  exertion,  a process  of  the  mind  above  mentioned, 
which  we  have  termed  intuitive  analogy.  Sect.  XVII.  3.  7. 

This  analogy  presupposes  an  acquired  knowledge  of  things, 
hence  children  and  ignorant  people  are  the  most  credulous,  as  not 
possessing  much  knowledge  of  the  usual  course  of  nature;  and 
secondly,  those  are  most  credulous,  whose  faculty  of  comparing 
ideas,  or  the  voluntary  exertion  of  it,  is  slow  or  imperfect.  Thus 
if  the  power  of  the  magnetic  needle  of  turning  towards  the  north, 
or  the  shock  given  by  touching  both  sides  of  an  electrized  coated 
jar,  was  related  for  the  first  time  to  a philosopher,  and  to  an  ig- 
norant person;  the  former  would  be  less  ready  to  believe  them 
than  the  latter;  as  he  would  find  nothing  similar  in  nature  to 
compare  them  to,  he  would  again  and  again  repeat  the  experi- 
ment, before  he  would  give  it  his  entire  credence;  till  by  these 


352 


.DISEASED 


Class  111.  2.  2.  4- 


repetitious  it  would  cease  to  be  a single  fact,  and  would  there- 
fore gain  the  evidence  of  analogy.  But  the  latter,  as  having  less 
knowledge  of  nature,  and  less  facility  of  voluntary  exertion,  would 
more  readily  believe  the  assertions  of  others,  or  a single  fact,  as 
presented  to  his  own  observation.  Of  this  kind  are  the  bulk  of 
mankind;  they  continue  throughout  their  lives  in  a stale  of  child- 
hood, and  have  thus  been  the  dupes  of  priests  and  politicians  in 
all  countries  and  in  all  ages  of  the  world. 

In  regard  to  religious  matters,  there  is  an  intellectual  coward- 
ice instilled  into  the  minds  of  the  people  from  their  infancy;  which 
prevents  their  inquiry:  credulity  is  made  an  indispensable  virtue; 
to  inquire  or  exert  their  reason  in  religious  matters  is  denounced 
as  sinful;  and  in  the  catholic  church  is  punished  with  more  se- 
vere penances  than  moral  crimes.  But  in  respect  to  our  belief 
of  the  supposed  medical  facts,  which  are  published  by  variety  of 
authors;  many  of  whom  are  ignorant,  and  therefore  credulous; 
the  golden  rule  of  David  Hume  may  be  applied  with  great  ad- 
vantage. “ When  tw’o  miraculous  assertions  oppose  each  other, 
believe  the  less  miraculous.”  Thus  if  a person  is  said  to  have 
received  the  small-pox  a second  time,  and  to  have  gone  through 
all  the  stages  of  it,  one  may  thus  reason:  twenty  thousand  people 
have  been  exposed  to  the  variolous  contagion  a second  time  with- 
out receiving  the  variolous  fever,  to  every  one  wrho  has  been  said 
to  have  thus  received  it;  it  appears,  therefore,  less  miraculous, 
that  the  assertor  of  this  supposed  fact  has  been  deceived,  or  wishes 
to  deceive,  than  that  it  has  so  happened  contrary  to  the  long  ex- 
perienced order  of  nature. 

M.  M.  The  method  of  cure  is  to  increase  our  knowledge  of 
the  laws  of  nature,  and  our  habit  of  comparing  whatever  ideas 
are  presented  to  us  with  those  known  laws,  and  thus  to  counter- 
act the  fallacies  of  our  senses,  to  emancipate  ourselves  from  the 
false  impressions  which  we  have  imbibed  in  our  infancy,  and  to 
set  the  faculty  of  reason  above  that  of  imagination. 


Class  IV. 


OP  ASSOCIATION. 


353 


The  Orders  and  Genera  of  the  Fourth  Class  of  Diseases. 

CLASS  IV. 

DISEASES  OF  ASSOCIATION. 

ORDO  I. 

Increased  dissociate  Motions, 

GENERA. 

1.  Catenated  with  irritative  motions. 

2.  Catenated  with  sensitive  motions. 

3.  Catenated  with  voluntary  motions. 

4.  Catenated  with  external  influences. 

ORDO  II. 

Decreased  Associate  Motions. 

GENERA. 

1.  Catenated  with  irritative  motions. 

2.  Catenated  with  sensitive  motions. 

3.  Catenated  with  voluntary  motions. 

4.  Catenated  with  external  influences. 

ORDO  III. 

Retrograde  Associate  Motions. 

GENERA. 

1.  Catenated  with  irritative  motions. 

2.  Catenated  with  sensitive  motions. 

3.  Catenated  with  voluntary  motions. 

4.  Catenated  with  external  influences. 


VOL.  II. 


z z 


354 


DISEASES 


Class  IV.  1.1. 


The  Orders,  Genera,  and  Species,  of  the  Fourth  Class 
of  Diseases. 


CLASS  IV. 


DISEASES  OF  ASSOCIATION. 


ORDO  I. 

Increased  Associate  Motions. 


GENUS  I. 

Catenated  with  Irritative  Motions. 

SPECIES. 


1 . Rubor  vulUts  pransorum. 

2.  Sudor  stragulus  immersorum. 

3.  Cessatio  cegritudinis  cute  cx- 

citata. 

4.  Digestio  aucta  frigore  cula- 

neo. 

5.  Catarrhus  a frigore  cutaneo. 

6.  Absorptio  cellularis  aucta 

vomitu. 

7.  Singultus  ncphriticus. 

8.  Febris  irritativa. 


Flushing  of  the  face  after  din- 
ner. 

Sweat  from  covering  the  face 
in  bed. 

Cure  of  sickness  by  stimulating 
the  skin. 

Digestion  increased  by  cold- 
ness of  the  skin. 

Catarrh  from  cold  skin. 

Cellular  absorption  increased 
by  vomiting. 

Nephritic  hiccough. 

Irritative  fever. 


GENUS  II. 

Catenated  with  Sensitive  Motions. 
SPECIES. 


1.  Lacrymarmn  fiuxus  sympa- 

theticus. 

2.  Stermtatio  a lumine. 

3.  Dolor  dentium  a stridore . 

4.  Risus  sardonicus. 

5.  Salivce  fiuxus  cibo  viso. 

6.  Tensio  mammulanm  viso 
puerulo. 

7.  Tensio  penis  in  hydrophobia. 


Sympathetic  tears. 

Sneezing  from  light. 

Tooth-edge  from  grating 
sounds. 

Sardonic  smile. 

Flux  of  saliva  at  sight  of  food. 

Tension  of  the  nipples  of  lac- 
tescent women  at  sight  of 
the  child. 

Tension  of  the  penis  in  hydro- 
phobia. 


Glass  IV.  1.  3. 


OF  ASSOCIATION. 


355 


8.  Tenesmus  calculosus. 

9.  Polypusnariumexascaride. 

10.  Crampus  surarum  in  diar- 

rhoea. 

1 1 . Zona  ignea  nephritica. 

12.  Eruptio  variolarum. 

13.  Gutta  rosea  stomatica. 

14.  hepatica. 

25.  Podagra. 

36.  Rheumatismus. 

17.  Erysipelas. 

18.  Testiumtumor  in  gonorrhoea. 

19.  in  parotitide. 


Tenesmus  from  stone. 

Polypus  of  the  nose  from  as- 
carides. 

Cramp  from  diarrhoea. 

Nephritic  shingles. 

Eruption  of  small-pox. 
Stomatic  rosy  drop. 

Hepatic  rosy  drop. 

Gout. 

Rheumatism. 

Erysipelas. 

Swelled  testis  in  gonorrhoea. 
in  mumps. 


GENUS  III. 


Catenated  with  Voluntary  Motions. 

SPECIES. 


1 . Deglutitio  invita. 

2.  Niclitatio  invita. 

3.  Risus  invitus. 

4.  Lusus  digitorum  invitus. 

5.  Unguium  morsiuncula  invita. 

6.  Vigilia  invita. 


Involuntary  deglutition. 

nictitation. 

laughter. 

actions  with  the 

fingers. 

biting  the  nails. 

watchfulness. 


GENUS  IV. 


Catenated  with  External  Influences. 

SPECIES. 


1.  Vita  ovi. 

2.  Vita  hiemi-dormientium. 

3.  Pullulatio  arborum. 

4.  Orgasmatis  venerei  periodus. 

5.  Brachii  concussio  electrica. 

6.  Oxygenatio  sanguinis. 

7.  Humectatio  corporis. 


Life  of  an  egg. 

Life  of  winter-sleepers. 
Budding  of  trees. 

Periods  of  venereal  desire. 
Electric  shock  through  the  arm. 
Oxygenation  of  the  blood. 
Humectation  of  the  body. 


ORDO  II. 

Decreased  Associate  Motions. 


GENUS  I. 

Catenated  with  Irritative  Motions. 

SPECIES. 

1.  Cutis  frigida  pransorum.  Chilness  after  dinner. 


356 


DISEASES 


Class  IV.  2.  1. 


2.  Pallor  urines  pransorum. 

3.  afrigore  cutaneo. 

4.  Pallor  ex  vegritudine. 

5.  Dyspnoea  a balneo  frigido. 

6 . Dyspepsia  a pedibusfrigidis. 

7.  Tussis  a pedibusfrigidis. 

8.  hepatica. 

9.  arthritica. 

10.  Vertigo  rotatoria. 

1 1 .  visualis. 

12.  ebriosa. 

13.  febriculosa. 

14.  cerebrosa. 

15.  Murmur  aurium  vertigino- 

sum. 

16.  Tactus,  gustus,  olfactusver- 

tiginosi. 

17.  Pulsus  mollis  a vomitione. 

18.  intermittens  a ven- 

triculo. 

19.  Febris  inirritativa. 


Pale  urine  after  dinner. 

from  cold  skin. 

Paleness  from  sickness. 
Shortness  of  breath  from  cold 
bathing. 

Indigestion  from  cold  feet. 
Cough  from  cold  feet. 
Liver-cough. 

Gout-cough. 

Vertigo  rotatory. 

visual. 

inebriate. 

feverish. 

from  the  brain. 

Noise  in  the  ears. 

Vertiginous  touch,  taste,  smell. 

Soft  pulse  in  vomiting. 
Intermittent  pulse  from  the 
stomach. 

Inirritative  fever. 


GENUS  II. 

Catenated  with  Sensitive  Motions. 


SPECIES. 


1.  Torpor  gence  a dolore  dentis. 

2.  Stranguria  a dolore  vcsicce. 

3.  convulsiva. 

4.  Dolor  termini  duettis  chole- 

dochi. 

5.  Dolor  pharyngis  abacido 

gastrico. 

6.  Pruritus  narium  a vermibus. 

7.  Cephalcea. 

8.  Hemicrania  et  otalgia. 

9.  Dolor  humeri  in  hepatidide. 

10.  Torpor  pedum  variola  emm- 

pente. 

1 1 . Testium  dolor  nephriticus. 

12.  Dolor  digiti  minimi  sympa- 

theticus. 


Coldness  of  the  cheek  from 
tooth-ach. 

Strangury  from  pain  of  the 
bladder. 

Convulsive  strangury. 

Pain  of  the  end  of  the  bile- 
duct. 

Pain  of  the  throat  from  gastric 
acid. 

Itching  of  the  nose  from  worms. 

Head-ach. 

Partial  head-ach,  and  ear-ach. 

Pain  of  shoulder  in  hepatitis. 

Cold  feet  in  eruption  of  small- 
pox. 

Nephritic  pain  of  testis. 

Pain  of  little  finger  from  sym- 
pathy. 


Class  IV.  2. 3.  OF  ASSOCIATION.  357 

13.  Dolor  brachii  in  Ivy  dr  ope  Pain  of  the  arm  in  dropsy  of 

pectoris.  the  chest. 

14.  Diarrhoea  a dentitione.  Diarrhoea  from  toothing. 

GENUS  III. 

Catenated  with  Voluntary  Motions. 

SPECIES. 

Impediment  of  speech. 

St.  Vitus’s  Dance. 

Laughter. 

Trembling  from  anger. 

Redness  from  anger. 

Blush  of  guilt. 

Slowness  from  palsy. 

of  age. 

GENUS  IV. 

Catenated  with  External  Influences. 

SPECIES. 

1.  Somni  periodus.  Periods  of  sleep. 

2.  Studii  inanis  periodus.  of  reverie. 

3.  Hemicranioe periodus.  ofhead-ach. 

4.  Epilepsiae  dolor  ificce periodus  of  painful  epilepsy. 

5.  Convulsionis  dolorificce  pe-  of  painful  convulsion. 

riodus. 

6.  Tussis periodical  periodus.  of  periodic  cough. 

7.  Catamenial  periodus.  of  catamenia. 

8.  Hoemorrhoidispenodus.  of  the  piles. 

9.  Podagrce  periodus.  of  the  gout. 

10.  Enjsipelatis periodus.  of  erysipelas. 

11.  Febrium  periodus.  of  fevers. 

ORDO  III. 

Retrograde  dissociate  Motions. 

GENUS  I. 

Catenated  with  Irritative  Motions. 

SPECIES. 

1.  Diabetes  irritata.  Diabetes  from  irritation. 

2.  Sudor  frigidus  in  asthinate.  Cold  sweat  in  asthma. 

3.  Diabetes  a timore.  Diabetes  from  fear. 

1.  Diarrhoea  a timore.  Diarrhoea  from  fear. 


1.  Titubatio  linguae. 

2.  Chorea  sancti  Viti. 

3.  Risus. 

4.  Tremore  ex  ir&. 

5.  Rubor  ex  ird. 

6.  criminati. 

7.  Tarditas  paralytica. 

8.  senilis. 


358 


DISEASES  Class  IV.  3.  2. 


5.  Pallor  et  tremor  a timore. 

6.  Palpitatio  cordis  a timore. 

7.  Jlbortio  a timore. 

8.  Hysteria  a timore. 


Paleness  and  trembling  from 
fear. 

Palpitation  of  the  heart  from 
fear. 

Abortion  from  fear. 

Hysterics  from  fear. 


GENUS  II. 

Catenated  with  Sensitive  Motions. 
SPECIES. 


1 . Nausea  idealis. 

2.  aconceptu. 

3.  Vomitio  vertiginosa. 

4.  a calculo  in  ure- 

tere. 

5.  ah  insultu  paraly- 

tico. 

6.  a titillatione  fau- 

cium. 

7.  cute  sympathetica. 


Nausea  from  ideas. 

Nausea  from  conception. 

Vomiting  from  vertigo. 

from  stone  in  the  ure- 
ter. 

from  stroke  of  palsy 

from  tickling  the 

throat. 

from  sympathy  with 

the  skin. 


GENUS  III. 

Catenated  with  Voluntary  Motions. 
SPECIES. 

1.  Ruminaiio.  Rumination. 

2.  Vomitio  voluntaria.  Voluntary  vomiting. 

3.  Eructatio  voluntaria.  eructation. 


GENUS  IV. 

Catenated  with  External  Influences. 
SPECIES. 


1 . Catarrhus  periodicus. 

2.  Tussis  periodica. 

3.  Hysteria  afrigore. 

4.  Nausea  pluvialis. 


Periodical  catarrh. 
Periodic  cough. 

H vsterics  from  cold. 
Sickness  against  rain. 


Giass  IV.  1. 1. 


OP  ASSOCIATION. 


359 


CLASS  IV. 

DISEASED  ASSOCIATIONS. 

ORDO  I. 

Increased  Associate  Motions . 

GENUS  I. 

Catenated  with  Irritative  Motions. 

The  importance  of  the  subsequent  class  not  only  consists  in 
its  elucidating  all  the  systematic  diseases,  but  in  its  opening  a 
road  to  the  lcnoivledge  of  fever.  The  difficulty  and  novelty  of  the 
subject  must  plead  in  excuse  for  the  present  imperfect  state  of 
it.  The  reader  is  entreated  previously  to  attend  to  the  follow- 
ing circumstances  for  the  greater  facility  of  investigating  their 
intricate  connections;  which  I shall  enumerate  under  the  follow- 
ing heads. 

A.  Associate  motions  distinguished  from  catenations. 

B.  Associate  motions  of  three  kinds. 

C.  Associations  affected  by  external  influences. 

D.  Associations  affected  by  other  sensorial  motions. 

E.  Associations  catenated  with  sensation. 

F.  Direct  and  reverse  sympathy. 

G.  Associations  affected  four  ways. 

H.  Origin  of  associations. 

I.  Of  the  action  of  vomiting. 

K.  Tertian  associations. 

A.  Associate  Motions  distinguished  from  Catenations. 

Associate  motions  properly  mean  only  those,  which  are  caused 
by  the  sensorial  power  of  association.  Whence  it  appears,  that 
those  fibrous  motions,  which  constitute  the  introductory  link  of 
an  associate  train  of  motions  are  excluded  from  this  definition,  as 
not  being  themselves  caused  by  the  sensorial  power  of  associa- 
tion, but  by  irritation,  or  sensation,  or  volition,  I shall  give  for  ex- 
ample the  flushing  of  the  face  after  dinner;  the  capillary  vessels 
of  the  face  increase  their  actions  in  consequence  of  their  catena- 
tion, not  their  association,  with  those  of  the  stomach;  which  latter 
are  caused  to  act  with  greater  energy  by  the  irritation  excited  by 
the  stimulus  of  food.  These  capillaries  of  the  face  are  associated 


360 


DISEASES 


Class  IV.  1. 1. 


with  each  other  reciprocally,  as  being  all  of  them  excited  by 
the  sensorial  power  of  association;  but  they  are  only  catenated 
with  those  of  the  stomach,  which  are  not  in  this  case  associate 
motions  but  irritative  ones.  The  common  use  of  the  word  as- 
sociation for  almost  every  kind  of  connection  has  rendered  this 
subject  difficult;  from  which  inaccuracy  I fear  some  parts  of  this 
work  are  not  exempt. 

B.  Associate  Motions  of  three  Kinds. 

Those  trains  or  tribes  of  associate  motions,  the  introductory 
Sink  of  which  consists  of  an  irritative  motion,  are  termed  irrita- 
tive associations;  as  when  the  muscles  of  the  eyelids  close  the 
eye  in  common  nictitation.  Those  whose  introductory  link  con- 
sists of  a sensitive  motion,  are  termed  sensitive  associations;  as 
when  the  pectoral  and  intercostal  muscles  act  in  sneezing. 
And  lastly,  those  whose  introductory  link  consists  of  a voluntary 
motion,  are  termed  voluntary  associations;  as  when  the  muscles 
of  the  lower  limbs  act  in  concert  with  those  of  the  arm  in  fencing. 

C.  Associations  affected  by  external  Influences. 

Circles  of  associate  motions,  as  well  as  trains  and  tribes  of 
them,  are  liable  to  be  affected  by  external  influences,  which  con- 
sist of  ethereal  fluids,  and  which,  by  penetrating  the  system,  act 
upon  it  perhaps  rather  as  a causa  sine  qua  non  of  its  movements, 
than  directly  as  a stimulus;  except  when  they  are  accumulated 
in  unusual  quantity.  We  have  a sense  adapted  to  the  perception 
of  the  excess  or  defect  of  one  of  these  fluids;  I mean  that  of 
elementary  heat;  in  which  all  things  are  immersed.  See  Class 
IV.  1.  4.  1.  But  there  are  others  of  them,  which,  as  we  have 
no  power  to  evade  their  influence,  so  we  have  no  sense  to  per- 
ceive it;  these  are  the  solar,  and  lunar,  and  terrestrial  gravitation, 
in  which  also  all  things  are  immersed;  the  electric  aura,  which 
pervades  us,  a*nd  is  perpetually  varying.  See  Class  IV.  1.  4. 
5;  the  magnetic  fluid,  Class  IV.  1.  4.  6;  and  lastly,  the  great 
life-preserver  oxygen  gas,  and  the  aqueous  vapour  of  the  atmo- 
sphere. See  Class  IV.  1.  4.  6.  and  7.  and  2. 

Of  these  external  influences  those  of  heat,  and  of  gravity, 
have  diurnal  periods  of  increase  and  decrease;  besides  their 
greater  periods  of  monthly  or  annual  variation.  The  manner 
in  which  they  act  by  periodical  increments  on  the  system,  till 
some  effect  is  produced,  is  spoken  of  in  Sect.  XXXII.  3.  and  6 


Class  IV.  1.  1. 


OF  ASSOCIATION. 


361 


D.  Associations  affected  by  other  Sensorial  Motions. 

Circles  and  trains  of  associate  motions  are  also  liable  to  be  af- 
fected by  their  catenations  with  other  sensorial  powers,  as  of  ir- 
ritation, or  sensation,  or  volition;  which  other  sensorial  powers 
either  thus  simply  form  some  of  the  links  of  the  catenation,  or  add 
to  the  energy  of  the  associated  motions.  Thus  when  vomiting 
is  caused  by  the  stimulus  of  a stone  in  the  ureter,  the  sensation  of 
pain  seems  to  be  a link  of  the  catenation  rather  than  an  efficient 
cause  of  the  vomiting.  But  when  the  capillary  vessels  of  the 
skin  increase  their  action  from  the  influence  of  external  heat, 
they  are  excited  both  by  the  stimulus  of  unusual  heat,  as  well 
as  by  the  stimulus  of  the  blood,  and  by  their  accustomed  associa- 
tion with  the  actions  of  the  heart  and  arteries.  And  lastly,  in 
the  blush  of  anger  the  sensorial  power  of  volition  is  added  to  that 
of  association,  and  irritation,  to  excite  the  capillaries  of  the  face 
with  increased  action.  See  Class  IV.  2.  3.  5. 

E.  Associations  catenated  with  Sensation. 

Pain  frequently  accompanies  associate  trains  or  circles  of  mo- 
tion without  its  being  a cause,  or  a link,  of  them,  but  simply  an 
attendant  symptom;  though  it  frequently  gives  name  to  the  dis- 
ease, as  head-ach.  Thus  in  the  cramp  of  the  calves  of  the  legs 
in  diarrhoea,  the  increased  sensorial  power  of  association  is  the 
proximate  cause;  the  preceding  increased  action  of  the  bowels  is 
the  remote  cause;  and  the  proximate  effect  is  the  violent  contrac- 
tions of  the  musculi  gastrocnemii;  but  the  pain  of  these  muscles 
is  only  an  attendant  symptom,  or  a remote  effect.  See  Sect. 
XVIII.  15.  Other  sensitive  associations  are  mentioned  in  Class 
IV.  1.2.  and  IV.  1.2.  15. 

Thus,  if  the  flushing  of  the  face  above  mentioned  after  dinner 
be  called  a disease,  the  immediate  or  proximate  cause  is  the  in- 
creased power  of  association,  the  remote  cause  is  the  increased 
irritative  motions  of  the  stomach  in  consequence  of  the  stimulus 
of  food  and  wine.  The  disease  or  proximate  effect  consists  in 
the  increased  actions  of  the  cutaneous  vessels  of  the  face;  and 
the  sensation  of  heat,  the  existence  of  heat,  and  the  red  colour, 
are  attendants  or  symptoms,  or  remote  effects,  of  the  increased 
actions  of  these  cutaneous  vessels. 

F.  Direct  and  reverse  Sympathy, 

The  increased  actions  of  the  primary  part  of  the  trains  of  as- 
sociated motions  are  sometimes  succeeded  by  increased  actions 

VOL.  it.  3 A 


362 


DISEASES' 


Class  IV.  1.  1; 


of  the  secondary  part  of  the  train;  and  sometimes  by  decreased 
actions  of  it.  So  likewise  the  decreased  actions  of  the  primary 
part  of  a train  of  associate  motions  are  sometimes  succeeded  by 
decreased  actions  of  the  secondary  part,  and  sometimes  by 
increased  actions  of  it.  The  former  of  these  situations  is  called 
direct  sympathy,  and  the  latter  reverse  sympathy.  In  general  I 
believe,  where  the  primary  part  of  the  train  of  associated  motions 
is  exerted  more  than  natural,  it  produces  direct  sympathy  in 
strong  people,  and  reverse  sympathy  in  weak  ones,  as  a full  meal 
makes  some  people  hot,  and  others  chill.  And  where  the  pri- 
mary part  of  the  train  is  exerted  less  than  natural,  it  produces 
direct  sympathy  in  weak  people,  and  reverse  sympathy  in  strong 
ones,  as  on  being  exposed  for  a certain  length  of  time  on  horse- 
back in  a cold  day  gives  indigestion  and  consequent  heart-burn 
to  weak  people,  and  strengthens  the  digestion,  and  induces  con- 
sequent hunger  in  strong  ones.  See  Sect.  XXXV.  1 . 

This  may  perhaps  be  more  easily  understood,  by  considering 
strength  and  weakness,  when  applied  to  animal  bodies,  as  con- 
sisting in  the  quantity  of  sensorial  powrer  residing  in  the  con- 
tracting fibres,  and  the  quantity  of  stimulus  applied,  as  shewn 
in  Sect.  XII.  2.  1.  Now  when  defective  stimulus,  within  certain 
limits,  is  partially  applied  to  parts  subject  to  perpetual  motion, 
the  expenditure  of  sensorial  power  is  for  a while  lessened,  but 
not  its  general  production  in  the  brain,  nor  its  derivation  into 
the  weakly  stimulated  part.  Hence  in  strong  people,  or  such 
whose  fibres  abound  with  sensorial  power,  if  the  first  tribe  of  an 
associate  train  of  motions  be  deprived  in  part  of  its  accustomed 
stimulus,  its  action  becomes  diminished,  and  the  sensorial  power 
becomes  accumulated,  and  by  its  superabundance,  or  overflowing 
as  it  were,  increases  the  action  of  the  second  tribe  of  the  associate 
actions  by  reverse  sympathy.  As  exposing  the  warm  skin  for 
a moderate  time  to  cold  air  increases  the  action  of  the  stomach, 
and  thus  strengthens  the  power  of  digestion. 

On  the  reverse,  when  additional  stimulus  within  certain  limits 
is  partially  applied  to  parts,  w'hich  are  deficient  in  respect  to 
the  natural  quantity  of  sensorial  power,  the  expenditure  of  sen- 
sorial power  is  increased,  but  in  a less  degree  than  the  increased 
production  of  it  in  the  brain,  or  its  increased  derivation  into  the 
strongly-stimulated  organ.  Hence  in  weak  people,  or  such 
whose  fibres  are  deficient  of  sensorial  power,  if  the  first  tribe  of 
an  associate  train  of  motions  be  subjected  for  a while  to  greater 
stimulus  than  usual,  a greater  production  of  sensorial  power,  or 
a greater  derivation  of  it  into  the  stimulated  parts  occurs;  which 
by  its  excess,  or  overflowing  as  it  were,  increases  the  actions  oi 
the  second  tribe  of  the  associate  motions  by  direct  sympathy 


Gxass  IV.  1. 1. 


OF  ASSOCIATION. 


363 

Thus  when  vomiting  occurs  with  cold  extremities,  a blister  on 
the  back  in  a few  hours  occasions  universal  warmth  of  the  skin, 
and  stops  the  vomiting.  And  when  a diarrhoea  occurs  with  pale 
skin  and  cold  extremities,  the  pricking  of  the  points  of  a flannel 
shirt,  worn  next  the  skin,  occasions  universal  warmth  of  it,  and 
checks  or  cures  the  diarrhoea. 

In  some  associate  trains  of  action,  nevertheless,  reverse  sym- 
pathies more  frequently  occur  than  direct  ones,  and  in  others  di- 
rect ones  more  frequently  than  reverse  ones.  Thus  in  continued 
fever  with  debility,  there  appears  to  be  a reverse  sympathy  be- 
tween thecapillary  vessels  of  the  stomach  and  those  of  the  skin; 
because  there  exists  a total  aversion  to  solid  food,  and  constant 
heat  on  the  surface  of  the  body.  Yet  these  two  systems  of  ves- 
sels are  at  other  times  actuated  by  direct  sympathy,  as  when  pale- 
ness attends  sickness,  or  cold  feet  induces  indigestion.  This  sub- 
ject requires  to  be  further  investigated,  as  it  probably  depends 
not  only  on  the  present  or  previous  plus  or  minus  of  the  sensorial 
power  of  association,  but  also  on  the  introduction  of  other  kinds 
of  sensorial  power,  as  in  Class  JV.  1.  1.  D.;  or  the  increased 
production  of  it  in  the  brain,  or  the  greater  mobility  of  one  part 
of  a train  of  actions  than  another. 

Thus  when  much  food  or  wine  is  taken  into  the  stomach,  if 
there  be  no  superfluity  of  sensorial  power  in  the  system,  that  is, 
none  to  be  spared  from  the  continual  actions  of  it,  a paleness  and 
chilness  succeed  for  a time;  because  now  the  expenditure  of  it 
by  the  increased  actions  of  the  stomach  is  greater  than  the  present 
production  of  it.  In  a little  time,  however,  the  stimulus  of  the 
food  and  wine  increases  the  production  of  sensorial  power  in  the 
brain,  and  this  produces  a superfluity  of  it  in  the  system;  in  con- 
sequence of  which,  the  skin  now  becomes  warm  and  florid, 
which  was  at  first  cold  and  pale;  and  thus  the  reverse  sympathy 
is  shortly  converted  into  a direct  one;  which  is  probably  owing 
to  the  introduction  of  a second  sensorial  power,  that  of  pleasur- 
able sensation. 

On  the  contrary,  when  an  emetic  drug  produces  sickness,  the 
skin  is  at  first  pale  for  a time  by  direct  sympathy  with  the  capil- 
laries of  the  stomach;  but  in  a few  minutes,  by  the  accumulation 
of  sensorial  power  in  the  stomach  during  its  less  active  state  in 
sickness,  the  capillaries  of  the  skin,  which  are  associated  with 
those  of  the  stomach,  act  with  greater  energy  by  reverse  sympa- 
thy, and  a florid  colour  returns.  Where  the  quantity  of  action  is 
diminished  in  the  first  part  of  a train  of  motions,  whethel*by  pre- 
vious diminution  of  sensorial  power,  or  present  diminution  of 
stimulus,  the  second  part  of  the  train  becomes  torpid  by  direct 
sympathy.  And  when  the  quantity  of  action  of  the  first  part 


364 


DISEASES 


Class  IV.  1.  1 


becomes  increased  by  the  accumulation  of  sensorial  power  dur- 
ing its  previous  torpor,  or  by  increase  of  stimulus,  the  actions  of 
the  second  part  of  it  likewise  become  increased  by  direct  sym- 
pathy. 

In  moderate  hunger  the  skin  is  pale,  as  before  dinner,  and  in 
moderate  sickness,  as  no  great  accumulation  of  sensorial  power 
has  commenced;  but  in  violent  hunger,  and  in  greater  torpor  of 
the  stomach,  as  from  contagious  matter,  the  accumulation  of  sen- 
sorial power  becomes  so  great  as  to  affect  the  arterial  and  capillary 
system,  and  fever  is  produced  in  both  cases. 

In  contagious  fevers  with  arterial  debility,  commencing  with 
torpor  of  the  stomach,  why  is  the  action  of  the  heart  weakened, 
and  that  of  the  capillaries  increased?  Is  it  because  the  mobility  of 
the  heart  is  less  than  that  of  the  stomach,  and  the  mobility  of  the 
capillaries  greater?  Or  is  it  because  the  association  between  the 
muscular  fibres  of  the  stomach  and  those  of  the  heart  have  been 
uniformly  associated  by  direct  sympathy;  and  the  capillaries  of 
the  stomach  and  those  of  the  skin  have  been  more  frequently  as- 
sociated by  reverse  sympathy? 

Where  the  actions  of  the  stomach  have  been  previously  ex- 
hausted by  long  stimulus,  as  on  the  day  after  intoxication,  little 
or  no  accumulation  of  sensorial  power  occurs,  during  the  torpor 
of  the  organ,  beyond  what  is  required  to  replace  the  deficiency  of 
it,  and  hence  fever  seldom  follows  intoxication.  And  a repetition 
of  the  stimulus  sometimes  becomes  necessary  even  to  induce  its 
natural  action,  as  in  dram-drinkers. 

Where  there  has  been  no  previous  exhaustion  of  sensorial 
power,  and  the  primary  link  of  associate  motions  is  violently  ac- 
tuated by  the  sensorial  power  of  sensation,  the  secondary  link  is 
also  violently  actuated  by  direct  sympathy;  as  in  inflammatory 
fevers.  Where,  however,  the  sensorial  power  of  the  system  is 
less  than  natural,  the  secondary  link  of  associated  motions  be- 
comes torpid  by  reverse  sympathy,  as  in  the  inoculated  small-pox 
during  the  eruption  on  the  face  the  feet  are  frequently  cold. 

G.  Associations  affected  four  Ways. 

Hence  associated  trains  or  circles  of  motions  may  be  affected 
four  different  ways.  1.  By  the  greater  or  less  energy  of  action 
of  the  first  link  with  which  they  are  catenated,  and  from  which 
they  take  their  names;  as  irritative,  sensitive,  or  voluntary  asso- 
ciations. 2.  By  being  excited  by  two  or  more  sensorial  powers 
at  the  same  time,  as  by  irritation  and  association,  as  in  the  in- 
stance of  the  application  of  the  stimulus  of  increased  external 
heat  to  the  cutaneous  capillaries.  3.  By  catenation  with  other 


Class  IV.  1.1. 


OF  ASSOCIATION. 


365 


sensorial  powers,  as  with  pain  or  pleasure,  which  are  in  this  case 
not  the  proximate  cause  of  motion,  but  which,  by  becoming  a 
link  of  catenation,  excite  the  sensorial  power  of  association  into 
action;  as  the  pain  at  the  neck  of  the  gall-bladder  occasioned 
by  a gall-stone  is  transferred  to  the  other  end  of  that  canal,  and 
becomes  a link  of  catenation  between  the  action  of  the  two  ex- 
tremities of  it.  4.  The  influence  of  ethereal  fluids,  as  of  heat 
and  gravitation.  To  which  last  perhaps  might  be  added  mois- 
ture and  oxygen  gas  as  constituting  necessary  parts  of  the  system, 
rather  than  stimuli  to  excite  it  into  action. 

H.  The  Origin  of  Associations. 

Some  trains  or  circles  of  associate  motions  must  have  been, 
formed  before  our  nativity,  as  those  of  the  heart,  arteries,  and 
capillaries;  others  have  been  associated,  as  occasion  required 
them,  as  the  muscles  of  the  diaphragm  and  abdomen  in  vomit- 
ing; and  others  by  perpetual  habit,  as  those  of  the  stomach  with 
the  heart  and  arteries  directly,  as  in  weak  pulse  during  sickness; 
with  the  capillaries  directly,  as  in  the  flushed  skin  after  dinner; 
and  lastly,  with  the  cellular  absorbents  reversely,  as  in  the  in- 
creased absorption  in  anasarca  during  sickness;  and  with  the  ir- 
ritative motions  of  the  organs  of  sense  reversely,  as  in  vertigo, 
or  sea-sickness.  Some  of  these  associations  shall  be  here  shortly 
described  to  facilitate  the  investigation  of  others. 

First,  other  congeries  of  glands  occupy  but  a particular  part 
of  the  system,  or  constitute  a particular  organ,  as  the  liver,  or 
kidneys;  but  those  glands,  which  secrete  the  mucus,  and  per- 
spirable matter,  which  are  called  capillaries,  are  of  very  great 
extent;  they  receive  the  blood  from  the  arteries,  separate  from 
it  the  mucus,  which  lines  every  cell,  and  covers  every  cavity  of 
the  body;  and  the  perspirable  matter,  which  softens  and  lubri- 
cates the  whole  surface  of  the  skin,  and  the  more  extensive  sur- 
face of  the  air  vessels,  which  compose  the  lungs.  These  are 
supplied  with  blood  by  the  perpetual  action  of  the  heart  and  ar- 
teries, and  have  therefore  their  motions  associated  with  the  for- 
mer, and  with  each  other,  by  sympathy,  which  is  sometimes  di- 
rect, and  sometimes  reverse. 

One  branch  of  this  association,  the  capillaries  of  the  skin,  is 
very  irritable  by  the  increased  quantities  of  cold  and  heat;  ano- 
ther branch,  that  of  the  lungs,  has  not  the  perception  of  cold 
and  heat,  but  is  liable  by  direct  sympathy  to  act  in  concert  with 
the  former,  as  in  going  into  the  cold  bath.  And  it  is  probable 
the  capillaries  of  the  internal  membranes  are  likewise  directly 


366 


DISEASES 


Class  IV.  1.  1. 


affected  by  their  sympathy  with  those  of  the  skin,  as  appears  from 
the  defect  of  secretion  in  ulcers  during  the  cold  fits  of  agues. 

The  motions  of  this  extensive  system  of  capillaries,  thus  asso- 
ciated by  direct  sympathy,  are  also  associated  with  those  of  the 
heart  and  arteries,  sometimes  by  reverse  and  sometimes  by  di- 
rect sympathy;  and  thus  constitute  simple  fever.  The  cold  pa- 
roxysm of  which  consists  in  their  torpor,  and  the  hot  one  in  their 
orgasm,  or  increased  activity. 

I.  Of  the  Action  of  Vomiting. 

The  manner  in  which  the  stomach  and  the  diaphragm  and 
abdominal  muscles  acquire  their  associate  action  in  vomiting, 
requires  some  attention.  It  is  not  probable  that  this  action  of 
vomiting  occurs  before  nativity;  as  the  uniform  application  of 
the  nutritive  liquor  amnii  to  the  mouth  of  the  foetus,  and  the 
uniform  expenditure  of  its  nourishment,  would  not  seem  to  give 
occasion  to  too  great  temporary  repletion  of  the  stomach;  and 
would  preclude  the  deglutition  of  any  improper  material.  After 
nativity  the  stomach  of  the  child  may  be  occasionally  too  much 
distended  with  milk;  as  previous  hunger  may  induce  it  to  over- 
gorge itself;  and  by  repeated  efforts  the  act  of  vomiting  is  learned, 
as  a means  of  getting  free  from  a disagreeable  sensation.  Thus 
when  any  disgustful  material,  as  a bitter  drug,  is  taken  into  the 
mouth;  certain  retrograde  motions  of  the  tongue  and  lips  are  pro- 
duced, for  the  purpose  of  putting  the  disagreeable  material  out  of 
the  mouth  again. 

When  the  stomach  is  disagreeably  stimulated  by  the  distention 
of  acrimony  of  the  aliment,  a similar  effort  to  regurgitate  it  must 
occur;  and  by  repeated  trials  the  action  of  the  diaphragm  and 
abdominal  muscles  by  squeezing  the  stomach  assists  its  retro- 
grade exertion  to  disgorge  its  contents.  In  the  same  manner 
when  a piece  of  gravel  is  pushed  into  the  urethra,  or  a piece  of 
indurated  bile  into  the  neck  of  the  gall-bladder,  after  they  have 
been  in  vain  pressed  forward  b.v  the  usual  motions  of  those 
ducts,  they  return  into  the  bladders  of  gall  and  urine  by  the  re- 
trograde motions  of  them. 

That  this  is  one  mode  in  which  vomiting  is  induced,  appears 
from  the  instantaneous  rejection  from  the  stomach  occasioned 
by  some  nauseous  drug,  or  from  some  nauseous  idea;  and  .lastly, 
from  the  voluntary  power,  which  some  people  have  been  said  to 
have  acquired,  of  emptying  their  stomachs,  much  in  the  same 
manner  as  ruminating  animals  bring  up  the  grass  from  their  first 
stomach. 

There  are  nevertheless  many  modes  by  which  these  inverted 


Class  IV.  1.  1. 


OF  ASSOCIATION. 


3.67 


motions  of  the  stomach  and  oesophagus  are  induced,  and  which 
it  is  of  consequence  to  distinguish  from  each  other.  The  first 
is  the  mode  above  described,  where  an  effort  is  made  to  dislodge 
something,  which  stimulates  the  stomach  into  disagreeable  sen- 
sation; and  which  is  returned  by  repeated  exertions;  as  when 
a nauseous  drug  is  taken  into  the  mouth,  or  a bit  of  sand  falls 
into  the  eye,  or  a drop  of  water  into  the  wind-pipe.  In  this 
the  peristaltic  motions  of  the  stomach  are  first  stopped,  and  then 
reverted  by  painful  sensation;  and  the  abdominal  muscles  and  di- 
aphragm by  repeated  efforts  become  associated  with  them.  Now 
as  less  sensorial  power  is  expended  on  the  retrograde  actions  of 
the  stomach,  and  of  the  lymphatics,  which  open  their  mouths 
on  its  surface,  than  by  their  natural  motions,  an  accumulation 
of  sensorial  power  in  the  fibres  of  the  stomach  follows  the  exhi- 
bition of  an  emetic,  and  on  that  account  an  emetic  will  some- 
times stop  a spontaneous  vomiting  which  was  owing  to  sensorial 
deficiency.  See  Sect.  XXXV.  1.  3.  and  Art.  V.  2.  1. 

As  bitters  and  metallic  salts,  exhibited  in  small  doses,  stimu- 
late the  stomach  into  greater  action,  as  appears  by  their  increas- 
ing the  power  of  digestion,  and  yet  become  emetic,  when  given 
in  larger  doses;  one  might  suspect  that  they  became  emetic 
by  inducing  debility,  and  consequent  retrograde  actions  of  the 
stomach,  by  their  previously  exhausting  the  sensorial  power  by 
their  great  stimulus;  which  might  be  effected  in  a moment 
without  producing  pain,  and  in  consequence  without  our  per- 
ceiving it.  But  on  the  contrary,  there  does  not  in  general  ap- 
pear on  the  exhibition  of  emetics  to  be  any  previous  exhaustion 
of  sensorial  power;  because  there  is  evidently  an  accumulation 
of  it  during  the  sickness,  as  appears  from  the  digestion  being 
stronger  afterwards;  and  from  the  increased  action  of  the  cellu- 
lar and  cutaneous  absorbents  during  its  operation.  See  Art.  V. 
2.  1. 

Another  mode  by  which  vomiting  is  induced,  is  owing  to  de- 
bility or  deficiency  of  sensorial  power,  from  the  previous  ex- 
haustion of  it;  as  on  the  day  after  intoxication,  or  which  occurs^ 
in  people  enfeebled  with  the  gout,  and  in  dropsy,  and  in  some 
fevers  with  debility.  In  these,  when  the  vomiting  ceases,  there 
is  no  appearance  of  accumulation  of  sensorial  power,  as  the  di- 
gestion still  remains  weak  and  imperfect. 

Another  mode  by  which  sickness  of  vomiting  is  induced,  is 
by  defect  of  stimulus,  as  in  great  hunger;  and  in  those,  who  have 
been  habituated  to  spice  and  spirit  with  their  meals,  who  are 
liable  to  be  sick  after  taking  food  without  these  additional  stimuli. 
Other  means  of  inducing  sickness  by  vertigo,  or  by  nauseous 
ideas,  will  be  mentioned  below. 


368 


DISEASES 


Class  IV.  1.  1. 


We  shall  only  add,  that  the  motions  of  the  muscular  fibres  of 
the  stomach  are'  associated  with  those  of  the  heart  and  arteries 
by  direct  sympathy,  as  appears  by  the  weakness  of  the  pulse  dur- 
ing the  exhibition  of  an  emetic;  and  that  the  absorbents  of  the 
stomach  are  associated  with  the  cellular  and  cutaneous  absorb- 
ents by  reverse  sympathy,  as  is  shown  by  the  great  absorption 
of  the  mucus  of  the  cells  in  anasarca  during  sickness;  at  the 
same  time  that  the  absorbents  of  the  stomach  invert  their  actions, 
and  pour  the  mucus  and  water  thus  absorbed  into  that  viscus. 

In  cold  paroxjsms  of  fever  the  stomach  partakes  of  the  gene- 
ral torpor,  and  vomiting  is  induced  by  its  debility,  either  by  its 
association  with  the  torpid  capillaries,  or  other  torpid  parts,  or 
by  its  own  torpor  commencing  first,  and  causing  the  cold  fit. 
The  disordered  motions  of  the  stomach  frequently  seem  to  be  the 
'Cause  or  primary  seat  of  fever  as  where  contagious  miasma  are 
swallowed  with  the  saliva,  and  where  fever  is  produced  by  sea- 
sickness, which  I once  saw.  Nevertheless  a disorder  of  the  sto- 
mach does  not  always  induce  fever,  as  in  that  case  it  should  con- 
stantly attend  indigestion,  and  vertigo,  and  sea-sickness;  but  is  it- 
self frequently  induced  by  association  with  the  disordered  move- 
ments of  other  parts  of  the  system,  as  when  it  arises  from  gra- 
vel in  the  ureter,  or  from  a percussion  on  the  head. 

The  connection  of  the  motions  of  the  stomach  with  irritative 
ideas,  or  motions  of  the  organs  of  sense,  in  vertigo,  is  shewn  in 
Sect.  XX.  and  thus  it  appears,  that  many  circles  of  association 
are  either  directly  or  reversely  associated,  or  catenated,  with  this 
viscus,  which  will  much  contribute  to  unfold  some  of  the  symp- 
toms of  fever. 


K.  Tertian  Associations. 

The  third  link  of  associate  trains  of  motion  is  sometimes  actu- 
ated by  reverse  sympathy,  with  the  second  link,  and  that  by  re- 
verse sympathy  with  the  first  link;  so  that  the  first  and  third  link 
may  act  by  direct  sympathy,  and  the  intermediate  one  by  reverse 
sympathy.  Of  this,  instances  are  given  in  the  singultus  nephri- 
ticus,  Class  IV.  1.  1.7.  and  IV.  2.  1.  At  other  times  the  tertian 
or  quartan  links  of  associate  motions  are  actuated  by  direct 
sympathy;  and  that  sometimes  forwards  and  sometimes  backwards 
in  respect  to  the  usual  order  of  those  trains  of  associate  motions, 
as  in  Class  IV.  1.  2.  1. 


SPECIES. 

1.  Rubor  vultuspransomn.  Flushing  of  the  face  after  dinner 


Class  IV.  1.  1. 2. 


OP  ASSOCIATION. 


369 


is  explained  in  Sect.  XXXV.  1 . In  the  beginning  of  intoxica- 
tion  the  whole  skin  becomes  florid  from  the  association  of  the  ac= 
tions  of  the  cutaneous  arteries  with  those  of  the  stomach,  be- 
cause vinous  spirit  excites  the  fibres  of  the  stomach  into  more 
violent  action  than  the  stimulus  of  common  food;  and  the  cu- 
taneous capillaries  of  the  face,  from  the  more  frequent  expo- 
sure to  the  vicissitudes  of  cold  and  heat,  possess  more  mobility  or 
irritability  than  those  of  other  parts  of  the  skin,  as  further  ex- 
plained in  Sect.  XXXIII.  2.  10.  Vinegar  is  liable  to  produce 
this  flushing  of  the  face,  which  probably  is  owing  to  the  quan- 
tity of  vinous  spirit  it  contains,  as  I believe  the  unfermented  ve- 
getable acids  do  not  produce  this  effect.  In  every  kind  of  blush 
the  arterial  blood  is  propelled  into  the  capillaries  faster  than  the 
venous  absorption  can  carry  it  forwards  into  the  veins,  in  this 
respect  resembling  the  tensio  phalli. 

Can  the  beginning  vinous  or  acetous  fermentation  of  the  ali- 
ment in  weak  stomachs  contribute  to  this  effect?  or  is  it  to  be 
ascribed  to  the  greater  power  of  association  between  the  arteries 
of  the  face  and  the  fibres  of  the  stomach  in  some  people  than  in 
others? 

M.  M.  Eat  and  drink  less  at  a time,  and  more  frequently. 
Put  20  drops  of  weak  acid  of  vitriol  into  water  to  be  drunk  at 
meals.  Let  the  dress  over  the  stomach  and  bowels  be  loose. 
Use  no  fermented  liquors,  or  vinegar,  or  spice. 

2.  Sudor  stragulis  immersorwm.  Sweat  from  being  covered  in 
bed.  In  the  commencement  of  an  epidemic  fever,  in  which  the 
perpetual  efforts  to  vomit  was  a distressing  symptom,  Dr.  Syd- 
enham discovered,  that  if  the  patient’s  head  was  for  a short  time 
covered  over  with  the  bed-clothes,  warmth  was  produced,  and 
a sweat  broke  out  upon  the  skin,  and  the  tendency  to  vomit  ceas- 
ed. In  this  curious  fact  two  trains  of  associated  motions  are 
excited  into  increased  action.  First,  the  vessels  of  the  lungs  are 
known  to  have  their  motion  associated  with  those  of  the  skin  by 
the  difficulty  of  breathing  on  going  into  the  cold  bath,  as  describ- 
ed in  Sect.  XXXII.  3.  2.  Hence,  when  the  vessels  of  the 
lungs  become  excited  into  stronger  action,  by  the  bad  air  under 
the  bed-clothes,  warmed  and  adulterated  by  frequent  breathing, 
those  of  the  external  skin  soon  become  excited  by  their  associ- 
ation into  more  energetic  action,  and  generate  more  heat  along 
with  a greater  secretion  of  perspirable  matter.  Secondly,  the 
sympathy  between  the  stomach  and  skin  is  evident  in  variety  of 
circumstances;  thus  the  cold  air  of  frosty  days  applied  to  the 
skin  for  a short  time  increases  the  action  of  the  stomach  by  re- 
verse sympathy,  but  decreases  it  if  continued  too  long  by  direct 
sympathy:  so  in  the  circumstance  above  mentioned,  the  action 

vor,.  it.  3 b 


370 


DISEASES 


Class  IV.  1.  1. 3 

of  the  stomach  is  increased  by  direct  sympathy  with  that  of  the 
skin;  and  the  tendency  to  vomit,  which  was  owing  to  its  di- 
minished action,  ceases. 

3.  Cessatio  wgritudinis  cute  excitata.  The  cure  of  sickness  by 
stimulating  the  skin.  This  is  explained  in  the  preceding  arti- 
cle; and  further  noticed  in  IV.  2.  2.  4.  and  in  IV.  1.  1.  F. 

Similar  to  these  is  the  effect  of  a blister  on  the  back  in  reliev 
ing  sickness,  indigestion,  and  heart-burn;  and,  on  the  contrary, 
by  these  symptoms  being  frequently  induced  by  coldness  of  the 
extremities.  The  blister  stimulates  the  cutaneous  vessels  into 
greater  action;  whence  warmth  and  pain  are  produced  at  the 
same  time,  and  the  fibres  of  the  stomach  are  excited  into  greater 
action  by  their  association  with  those  of  the  skin.  It  does  not 
appear,  that  the  concomitant  pain  of  the  blister  causes  the  in- 
creased energy  of  the  stomach,  because  the  motions  of  it  are  not 
greater  than  natural;  though  it  is  sometimes  difficult  to  deter- 
mine, whether  the  primary  part  of  some  associated  trains  be 
connected  with  irritative  or  sensitive  motions. 

In  the  same  manner  a flannel  shirt,  to  one  who  has  not  been 
in  the  habit  of  wearing  one,  stimulates  the  skin  by  its  points, 
and  thus  stops  vomiting  in  some  cases;  and  is  particularly  effi- 
cacious in  checking  some  chronical  diarrhoeas,  which  are  not  at- 
tended with  fever;  for  the  absorbents  of  the  skin  are  thus  sti- 
mulated into  greater  action,  with  which  those  of  the  intestines 
consent  by  direct  sympathy. 

This  effect  cannot  be  ascribed  to  the  warmth  alone  of  the 
flannel  shirt,  as  being  a covering  of  loose  texture,  and  coufining 
air  in  its  pores,  like  a sponge,  which  air  is  known  to  be  a bad 
conductor  of  heat,  since  in  that  case  its  use  should  be  equally 
efficacious,  if  it  were  worn  over  a linen  shirt;  and  an  increased 
warmth  of  the  room  of  the  patient  would  be  equally  serviceable. 

4.  Digcslio  aucta  frigore  cutanco.  Digestion  increased  by  cold- 
ness of  the  skin.  Every  one  has  experienced  the  increase  of 
his  appetite  after  walking  in  the  cool  air  in  frosty  days;  for 
there  is  at  this  time  not  only  a saving  of  sensorial  power  by  the 
less  exertion  of  the  cutaneous  vessels;  but,  as  these  consent  with 
those  of  the  stomach  and  bowels,  this  saving  of  sensorial  power 
is  transferred  by  reverse  sympathy  from  the  cutaneous  capilla- 
ries and  absorbents  to  those  of  the  stomach  and  intestines. 

Hence  weak  people  should  use  the  cold  air  of  winter  as  a cold 
bath;  that  is,  they  should  slay  in  it  but  a short  time  at  once, 
but  should  immerse  themselves  in  it  many  times  a day. 

5.  Catarrhus  a frigore cutaneo.  Catarrh  from  cold  skin.  This 
has  been  already  explained  in  Class  I.  1.2.  7.  and  is  further 
described  in  Sect.  XXXV.  I.  3.  In  this  disease  the  vessels  f 


Gf  ass  IV.  1. 1.  6. 


OF  ASSOCIATION. 


371 


the  membrane,  which  lines  the  nostrils,  are  excited  into  greater 
action;  when  those  of  the  skin,  with  which  they  are  associated, 
are  excited  into  less  action  by  the  deficiency  of  external  heat, 
by  reverse  sympathy;  and  though  the  pain  of  cold  attends  the 
torpor  of  the  primary  link  of  this  association,  yet  the  increased 
motions  of  the  membrane  of  the  nostrils  are  associated  with  those 
of  the  cutaneous  vessels,  and  not  with  the  pain  of  them,  because 
no  inflammation  follows. 

6.  Absorptio  cellularis  aucta  vomitu.  In  the  act  of  vomiting 
the  irritative  motions  of  the  stomach  are  inverted,  and  of  the  ab- 
sorbents, which  open  their  mouths  into  it;  while  the  cutaneous, 
cellular,  and  pulmonary  absorbents  are  induced,  by  reverse  sym- 
pathy with  them,  to  act  with  greater  energy.  This  is  seen  in 
cases  of  anasarca,  when  long  sickness  and  vomiting  are  caused 
by  squills,  or  antimonial  salts,  or  most  of  all  by  the  decoction  of 
digitalis  purpurea,  foxglove;  and  Mr.  J.  Hunter  mentions  a case, 
in  wrhich  a large  bubo,  which  w'as  just  ready  to  break,  was  ab- 
sorbed in  a fewf  days  by  sickness  at  sea.  Treatise  on  the  Blood, 
p.  501,  which  is  thus  accounted  for;  less  sensorial  power  is  ex- 
pended during  sickness  by  the  decreased  action  of  the  fibres  of 
the  stomach,  and  of  its  absorbents;  as  shewn  in  Sect.  XXXV. 
1.  3.  whence  an  accumulation  of  it  is  produced,  and  there  is  in 
consequence  a greater  quantity  of  sensorial  power  for  the  exertion 
of  those  motions,  which  are  associated  wfiththe  absorbents  of  the 
stomach  by  reverse  sympathy. 

The  reverse  sympathy  between  the  lacteal  and  lymphatic 
branches  of  the  absorbent  system  have  been  produced  by  the  one 
branch  being  less  excited  to  act,  when  the  other  supplies  sufficient 
fluid  or  nutriment  to  the  sanguiferous  vessels.  Thus  when  the 
stomach  is  full,  and  the  supply  of  chyle,  and  mucus,  and  water  is 
in  sufficient  quantity;  the  pulmonary,  cellular,  and  cutaneous  lym- 
phatics  are  not  excited  into  action;  whence  the  urine  is  pale, 
and  the  skin  moist,  from  the  defect  of  absorption  on  those  sur- 
faces. 

7.  Singultus  nephriticus.  When  a stone  irritates  the  ureter, 
and  that  even  without  its  being  attended  with  pain  or  fever, 
sometimes  a chronical  hiccough  occurs,  and  continues  for  days 
and  weeks,  instead  of  sickness  or  vomiting;  which  are  the  com- 
mon symptoms.  In  this  case  the  motions  of  the  stomach  are 
decreased  by  their  sympathy  with  those  of  the  ureter,  which  are 
increased  by  the  stimulus  of  the  stone  in  it;  and  the  increased 
motions  of  the  diaphragm  seem  to  exist  in  consequence  of  their 
association  with  the  stomach  by  a second  reverse  sympathy.  This 
hiccough  may  nevertheless  admit  of  another  explanation,  and 
be  supposed  to  be  a convulsive  exertion  of  the  diaphragm  to  re- 


3T2 


DISEASES 


G'li ass  IV.  1.1.  8. 


lieve  the  disagreeable  sensation  of  the  stomach  in  consequence  of 
its  disordered  irritative  associations;  and  in  that  case  it  would 
belong  to  Class  III.  1.1.  See  Class  IV.  2.  1.  for  another  exam- 
ple of  tertiary  association. 

M.  M.  Venesection.  Emetic.  Calomel.  Cathartic,  opium, 
oil  of  cinnamon,  from  two  to  ten  drops.  Aerated  alkaline  water. 
Peruvian  bark. 

8.  Febris  Irritativci.  Irritative  fever,  described  in  Class  I.  1. 
1.1.  The  diseases  above  explained  in  this  genus  are  chiefly  con- 
cerning the  sympathies  of  the  absorbent  system,  or  the  alimentary 
canal,  which  are  not  so  much  associated  with  the  arterial  system 
as  to  throw  it  into  disorder,  when  they  are  slightly  deranged;  but 
when  any  great  congeries  of  conglomerate  glands,  which  may  be 
considered  as  the  extremities  of  the  arterial  system,  are  affected 
with  torpor,  the  whole  arterial  system  and  the  heart  sympathize 
with  the  torpid  glands,  and  act  with  less  energy;  which  consti- 
tutes the  cold  fit  of  fever;  which  is  therefore  at  first  a decreased 
action  of  the  'associate  organ;  but  as  this  decrease  of  action  is 
only  a temporary  effect,  and  an  increase  of  exertion  both  of  the 
torpid  glands,  and  of  the  whole  arterial  system,  soon  follows;  the 
hot  fit  of  irritative  fever,  or  fever  with  strong  pulse,  properly  be- 
longs to  this  class  and  genus  of  diseases. 


Class  IV.  1.  2. 


OF  ASSOCIATION. 


ORDO  I. 

Increased  Associate  Motions. 

GENUS  II. 

Catenated  with  Sensitive  Motions. 

The  primary  links  of  the  associated  actions  of  this  genus  are 
either  produced  or  attended  by  painful  or  pleasurable  sensation. 
The  secondary  links  of  the  first  ten  species  are  attended  with 
increased  motions  without  inflammation,  those  of  the  remainder 
are  attended  with  inflammation.  All  inflammations,  which  do 
not  arise  in  the  part  which  was  previously  torpid,  belong  to  this 
genus;  as  the  gout,  rheumatism,  erysipelas.  It  is  probable  many 
other  inflammations  may,  by  future  observation,  require  to  be 
transplanted  into  this  class. 

The  circles  of  sensitive  associate  motions  consist  chiefly  of  the 
excretory  ducts  of  the  capillaries  and  of  the  mouths  of  the  ab- 
sorbent vessels,  which  constitute  the  membranes;  and  which 
have  been  induced  into  action  at  the  same  time;  or  they  consist 
of  the  terminations  of  canals;  or  of  parts  which  are  endued 
with  greater  sensibility  than  those  which  form  the  first  link  of 
the  association.  An  instance  of  the  first  of  those  is  the  sympa- 
thy between  the  membranes  of  the  alveolar  processes  of  the  jaws, 
and  the  membranes  above  or  beneath  the  muscles  about  the 
temples  in  hemicrania.  An  instance  of  the  second  is  in  the 
sympathy  between  the  excretory  duct  of  the  lachrymal  gland,  and 
the  nasal  duct  of  the  lachrymal  sac.  And  an  instance  of  the 
third  is  the  sympathy  between  the  membranes  of  the  liver,  and 
the  skin  of  the  face  in  the  gutta  rosea  of  inebriates. 

SPECIES. 

1 . Lachrymarum  Jluxus  sympatheticus.  A flow  of  tears  from 
grief  or  joy.  When  the  termination  of  the  duct  of  the  lachry- 
mal sac  in  the  nostrils  becomes  affected  either  by  painful  or 
pleasurable  sensations,  in  consequence  of  external  stimulus,  or 
by  its  association  with  agreeable  or  disagreeable  ideas,  the  mo- 
tions of  the  lachrymal  gland  are  at  the  same  time  exerted  with 
greater  energy,  and  a profusion  of  tears  succeeds  by  sensitive  as- 
sociation as  explained  in  Sect.  XVI.  8.  2. 

In  this  case  there  exists  a chain  of  associated  actions,  the  se- 
cretion of  the  lachrymal  gland  is  increased  by  whatever  stimu- 


DISEASES 


Class  IV.  1.  2. 2. 


3U 

lates  the  surface  of  the  eye,  at  the  same  time  the  increased  abun- 
dance of  tears  stimulates  the  puncta  lachrymalia  into  greater  ac- 
tion; and  the  fluid  thus  absorbed  stimulates  the  lachrymal  sac, 
and  its  nasal  duct  in  the  nose  into  greater  action.  In  a contrary 
direction  of  this  chain  of  association  the  present  increase  of 
action  is  induced.  First,  the  nasal  duct  of  the  lachrymal  sac  is 
excited  into  increased  action  by  some  pleasurable  or  painful  idea, 
as  described  in  Sect.  XVI.  8.  2.  2d.  The  puncta  lachrymalia 

or  other  extremity  of  the  lachrymal  sac  sympathizes  with  ii  (as 
the  two  ends  of  all  other  canals  sympathize  with  each  other.) 
3d.  With  these  increased  motions  of  the  puncta  lachrymalia  those 
of  the  excretory  duct  of  the  lachrymal  gland  are  associated  from 
their  having  so  perpetually  acted  together.  And,  lastly,  with 
the  increased  actions  of  the  excretory  duct  of  this  gland  are  as- 
sociated those  of  the  other  end  of  it  by  their  frequently  acting 
together;  in  the  same  manner  as  the  extremities  of  other  ca- 
nals are  associated,  and  thus  a greater  flow  of  tears  is  poured 
into  the  eye. 

When  a flow  of  tears  is  produced  in  grief,  it  is  believed  to 
relieve  the  violence  of  it,  which  is  worthy  a further  inquiry. 
Painful  sensations,  when  great,  excite  the  faculty  of  volition; 
and  the  person  continues  voluntarily  to  call  up  or  perform  those 
ideas,  which  occasion  the  painful  sensation;  that  is,  the  afiiicted 
person  becomes  so  far  insane  or  melancholy;  but  tears  are 
produced  by  the  sensorial  faculty  of  association,  and  shew  that 
the  pain  is  so  far  relieved  as  not  to  excite  the  excessive  power  of 
volition,  or  insanity,  and  are  therefore  a sign  of  the  abatement  of 
the  painful  state  of  grief,  rather  than  a cause  of  that  abatement. 
See  Class  III.  1.  2.  10. 

2.  Sternutatio  a lumine.  Some  persons  sneeze  from  looking 
up  at  the  light  sky  in  a morning  after  coming  out  of  a dark 
bed  room.  The  olfactory  nerves  are  brought  into  too  great  ac- 
tion by  their  sympathy  with  the  optic  nerves,  or  by  their  respec- 
tive sympathies  with  some  intervening  parts,  as  probably  with 
the  two  extremities  of  the  lachrymal  sac;  that  is,  with  the  punc- 
ta lachrymalia  and  the  nasal  duct.  See  Class  II.  1.  1.  3. 

3.  Dolor  dentium  a stridore.  Tooth-edge  from  grating  sounds, 
and  from  the  touch  of  certain  substances,  and  even  from  ima- 
gination alone,  is  described  and  explained  in  Sect.  XVI.  10. 
The  increased  actions  of  the  alveolar  vessels  or  membranes  are 
associated  with  the  ideas,  or  sensual  motions  of  the  auditory 
nerves  in  the  first  case;  and  of  those  of  the  sense  of  touch,  in 
the  second  case;  and  by  imagination,  or  ideas  exerted  of  painful 
sensation  alone,  in  the  last. 

4.  Risus  sardoniens.  A disagreeable  smile  attends  inflammation? 


Class  IV.  1.  % 5. 


OP  ASSOCIATION. 


375 


of  the  diaphragm  arising  from  the  associations  of  the  reiterated 
exertions  of  that  muscle  with  those  of  the  lips  and  cheeks  in 
laughing.  See  Diaphragmitis,  Class  II.  1.  2.  6. 

5.  Saliva  Jluxus  cibo  viso.  The  flow  of  saliva  into  the  mouths 
of  hungry  animals  at  the  sight  or  smell  of  food  is  seen  in  dogs 
standing  round  a dinner-table.  The  increased  actions  of  the 
salivary  glands  have  been  usually  produced  by  the  stimulus  of 
agreeable  food  on  their  excretory  ducts  during  the  mastication 
of  it;  and  with  this  increased  action  of  their  excretory  ducts  the 
other  terminations  of  those  glands  in  the  capillary  arteries  have 
been  excited  into  increased  action  by  the  mutual  association  of 
the  ends  of  canals;  and  at  the  same  time  the  pleasurable  ideas, 
or  sensual  motions,  of  the  sense  of  smell  and  of  sight  have  accom- 
panied this  increased  secretion  of  saliva.  Hence  this  chain  of 
motions  becomes  associated  with  those  visual  or  olfactory  ideas, 
or  with  the  pleasure,  which  produces  or  attends  them. 

6.  Tensio  mammularum  viso  puerulo.  The  nipples  of  lactescent 
women  are  liable  to  become  turgid  at  the  sight  of  their  young 
offspring.  The  nipple  has  generally  been  rendered  turgid  by 
the  titillation  of  the  lips  or  gums  of  the  child  in  giving  suck; 
the  visible  idea  of  the  child  has  thus  frequently  accompanied 
this  pleasurable  sensation  of  parting  with  the  milk,  and  turges- 
cenee  of  the  tubes,  which  constitute  the  nipple.  Hence  the 
visual  idea  of  the  child,  and  the  pleasure  which  attends  it,  be- 
come associated  with  those  increased  arterial  actions,  which 
swell  the  cells  of  the  mammula,  and  extend  its  tubes;  which  is 
very  similar  to  the  tensio  phalli  visa  muliere  nuda  etiam  in  in- 
somnio. 

7.  Tensio  penis  in  hydrophobia.  An  erection  of  the  penis  oc- 
curs in  the  hydrophobia,  and  is  a troublesome  symptom,  as  ob- 
served by  Ccelius  Aurelianus,  Fothergill,  and  Vaughan,  and 
w'ould  seem  to  be  produced  by  an  unexplained  sympathy  between 
the  sensations  about  the  fauces  and  the  penis.  In  men  the  hair 
grows  about  both  these  parts,  the  voice  changes,  and  the  neck 
thickens  at  puberty.  In  the  mumps,  when  the  swellings  about 
the  throat  subside,  the  testicles  are  liable  to  swell.  Venereal  in- 
fection received  by  the  penis  is  very  liable  to  affect  the  throat 
with  ulcers,  Violent  coughs,  with  soreness  or  rawness  about 
the  fauces,  are  often  attended  with  erection  of  the  penis;  which 
is  also  said  to  happen  to  male  animals,  that  are  hanged;  which 
last  circumstance  has  generally  been  ascribed  to  the  obstruction 
of  the  circulation  of  the  blood,  but  is  more  probably  occasioned 
by  the  stimulus  of  the  cord  in  compressing  the  throat;  since  if 
it  was  owing  to  impeded  circulation  it  ought  equallv  to  occur  in 
drowning  animals. 


376 


DISEASES 


Class  IV.  1.2. -8, 


la  men  the  throat  becomes  so  thickened  at  the  time  of  pu- 
berty, that  a measure  of  this  is  used  to  ascertain  the  payment  of  a 
poll-tax  on  males  in  some  of  the  islands  of  the  Mediterranean, 
which  commences  at  puberty;  a string  is  wrapped  twice  round 
the  thinnest  part  of  the  neck,  the  ends  of  it  are  then  put  into 
each  corner  of  the  mouth;  and  if,  when  thus  held  in  the  teeth,  it 
passes  readily  over  the  head,  the  subject  is  taxable. 

It  is  difficult  to  point  out  by  what  circumstance  the  sensitive 
motions  of  the  penis  and  of  the  throat  and  nose  become  associ- 
ated; I can  only  observe,  that  these  parts  are  subjected  to  greater 
pleasurable  sensations  than  any  other  parts  of  the  body;  one 
being  designed  to  preserve  ourselves  by  the  pleasure  attending 
the  smell  and  deglutition  of  food,  and  the  other  to  ensure  the 
propagation  of  our  species:  and  may  thus  gain  an  association  of 
their  sensitive  motions  by  their  being  eminently  sensible  to  plea- 
sure. See  Class  I.  3.  1.11.  and  III.  1.  1.  15.  and  Sect.  XVI.  5. 
See  Gonorrhoea  venerea,  II.  1.  5.  1. 

In  the  female  sex  this  association  between  the  face,  throat, 
nose,  and  pubis,  does  not  exist:  whence  no  hair  grows  on  their 
chins  at  the  time  of  puberty,  nor  do  their  voices  change,  or  their 
necks  thicken.  This  happens  probably  from  there  being  in  them 
a more  exquisite  sensitive  sympathy  between  the  pubis  and  the 
breasts.  Hence  their  breasts  swell  at  the  time  of  puberty,  and 
secrete  milk  at  the  time  of  parturition.  And  in  the  parotitis,  or 
mumps,  the  breasts  of  women  swell,  when  the  tumour  of  the  paro- 
titis subsides.  See  Class  I.  1.2.  15.  Whence  it  would  appear, 
that  their  breasts  possess  an  intermediate  sympathy  between  the 
pubis  and  the  throat;  as  they  are  the  seat  of  a passion,  which 
men  do  not  possess,  that  of  suckling  children. 

8.  Tenesmus  calculosus.  The  sphincter  of  the  rectum  becomes 
painful  or  inflamed  from  the  association  of  its  sensitive  motions 
with  those  of  the  sphincter  of  the  bladder,  when  the  latter  is 
stimulated  into  violent  pain  or  inflammation  by  a stone. 

9.  Polypus  narium  ex  asenridibus ? The  stimulation  of  asca- 
rides  in  the  rectum  produces,  by  sensitive  sympathy,  an  itching  ol 
the  nose,  as  explained  in  IV.  2.  2.  6;  and  in  three  children  I 
have  seen  a polypus  in  the  nose,  who  were  all  affected  with  asca- 
rirles;  to  the  perpetual  stimulation  of  which,  and  the  consequent 
sensitive  association,  I was  led  to  ascribe  the  inflammation  aud 
thickening  of  the  membrane  of  the  nostrils. 

10.  Crampus  surarum  in  cholera.  A cramp  of  the  muscles  of 
the  legs  occurs  in  violent  diarrhoea,  or  cholera,  and  from  the 
use  of  too  much  acid  diet  in  gouty  habits.  This  seems  to  sym- 
pathize with  uneasy  sensation  in  the  bowels.  See  Class  III.  1 
1.  14.  This  association  is  not  easily  accounted  for.  but  is  analo- 


CiassIV.  1.2.  11. 


OF  ASSOCIATION. 


377 


gous  in  some  degree  to  the  paralysis  of  the  muscles  of  the  arms 
in  colica  saturnina.  It  would  seem,  that  the  muscles  of  the  legs 
in  walking  get  a sympathy  with  the  lower  parts  of  the  intestines, 
and  those  of  the  arm  in  variety  of  employment  obtain  a sympa- 
thy with  the  higher  parts  of  them.  See  ChSlera  and  Ileus. 

11.  Zona  ignea  nephritica.  Nephritic  shingles.  The  exter- 
nal skin  about  the  loins  and  sides  of  the  belly  I suppose  to  have 
greater  mobility  in  respect  to  sensitive  association,  than  the  ex- 
ternal membrane  of  the  kidney;  and  that  their  motions  are  by 
some  unknown  means  thus  associated.  When  the  torpor  or  be- 
ginning inflammation  of  this  membrane  ceases,  the  external  skin 
becomes  inflamed  in  its  stead,  and  a kind  of  herpes,  called  the 
shingles,  covers  the  loins  and  sides  of  the  belly.  See  Class  II. 
1.  5.  9. 

12.  Eruptio  variolarum.  After  the  inflammation  of  the  in- 
oculated arm  has  spread  for  a quarter  of  a lunation,  it  affects  the 
stomach  by  reverse  sympathy;  that  is,  the  actions  of  the  stomach 
are  associated  with  those  of  the  skin;  and  as  much  sensorial 
power  is  now  exerted  on  the  inflamed  skin,  the  other  part  of 
this  sensitive  association  is  deprived  of  its  natural  share,  and  be- 
comes torpid,  or  inverts  its  motions.  After  this  torpor  of  the 
stomach  has  continued  a time,  and  much  sensorial  power  is  thus 
accumulated;  other  parts  of  the  skin,  which  are  also  associated 
with  it,  as  that  of  the  face  first,  are  thrown  into  partial  in- 
flammation; that  is,  the  eruptions  of  the  small-pox  appear  on 
the  face. 

For  that  the  variolous  matter  affects  the  stomach  previous  to 
its  eruption  on  the  skin,  appears  from  the  sickness  at  the  com- 
mencement of  the  fever;  and  because,  when  the  morbid  motions 
affect  the  skin,  those  of  the  stomach  cease;  as  in  the  gout  and 
erysipelas,  mentioned  below.  The  consent  between  the  stomach 
and  the  skin  appears  in  variety  of  other  diseases;  and  as  they 
both  consist  of  surfaces,  which  absorb  and  secrete  a quantity  of 
moisture,  their  motions  must  frequently  be  produced  together, 
or  in  succession;  which  is  the  foundation  of  all  the  sympathies 
of  animal  motions,  whether  of  the  irritative,  sensitive,  or  volun- 
tary kinds. 

Now  as  the  skin,  which  covers  the  face,  is  exposed  to  greater 
variations  of  heat  and  cold  than  any  other  part  of  the  body;  it 
probably  possesses  more  mobility  to  sensitive  associations,  not 
only  than  the  stomach,  but  than  any  other  part  of  the  skin;  and 
is  thence  affected  at  the  eruption  of  the  small-pox  with  violent 
action  and  consequent  inflammation,  by  the  association  of  its  mo- 
tions with  those  of  the  stomach,  a day  before  the  other  parts  of 

VOL.  II.  3 c 


378 


DISEASES 


Class  IV.  1.  2.  13. 


the  skin:  and  becomes  fuller  of  pustules,  than  any  other  part  of 
the  body.  See  Class  II.  1.  3.  9. 

It  might  be  supposed,  that  the  successive  swelling  of  the  hands, 
when  the  face  subsides,  at  the  height  of  the  small-pox,  and  of  the 
feet,  when  the  hancte  subside,  were  governed  by  some  unknown 
associations  of  those  parts  of  the  system;  but  these  successions  of 
tumour  and  subsidence  more  evidently  depend  on  the  times  of 
the  eruption  of  the  pustules  on  those  parts,  as  they  appear  a day 
sooner  on  the  face  than  on  the  hands,  and  a day  sooner  on  the 
hands  than  on  the  feet,  owing  to  the  greater  comparative  mobi- 
lity of  those  parts  of  the  skin. 

13.  Gutta  rosea  stomatica.  Stomatic  red  face.  On  drinking 
cold  water,  or  cold  milk,  when  heated  with  exercise,  or  on  eat- 
ing cold  vegetables,  as  raw  turnips,  many  people  in  harvest-time 
have  been  afflicted  with  what  has  been  called  a surfeit.  The 
stomach  becomes  painful,  with  indigestion  and  flatulency,  and 
after  a few  days  an  eruption  of  the  face  appears,  and  continues 
with  some  relief,  but  not  with  entire  relief;  as  both  the  pimpled 
face  and  indigestion  are  liable  to  continue  even  to  old  age. 

M.  M.  Venesection.  A cathartic  with  calomel.  Then  half  a 
grain  of  opium  twice  a day  for  many  weeks.  If  saturated  solu- 
tion of  arsenic  three  or  five  drops  twice  or  thrice  a day  for  a 
week? 

14.  Gulta  rosea  hepatica.  The  rosy  drop  of  the  face  of  some 
drinking  people  is  produced  like  the  gout  described  below,  in 
consequence  of  an  iuflamed  liver.  In  these  constitutions  the 
skin  of  the  face  being  exposed  to  greater  variation  of  heat  and 
cold  than  the  membranes  of  the  liver,  possesses  more  mobility 
than  those  hepatic  membranes;  and  hence  by  whatever  means 
these  membranes  are  induced  to  sympathize,  when  this  sensitive 
association  occurs,  the  cutaneous  vessels  of  the  face  run  into 
greater  degrees  of  those  motions,  which  constitute  inflammation, 
than  previously  existed  in  the  membranes  of  the  liver;  and  then 
those  motions  of  the  liver  cease.  See  Class  II.  1.  4.  6. 

As  inflammation  of  the  liver  so  frequently  attends  the  great 
potation  of  vinous  spirit,  there  is  reason  to  suspect,  that  this  vis- 
cus  itself  becomes  inflamed  by  sensitive  association  with  the  sto- 
mach; or  that,  when  one  termination  of  the  bile-duct,  which  en- 
ters the  duodenum,  is  stimulated  violently,  the  other  end  may 
become  inflamed  by  sensitive  association. 

15.  Podagra.  The  gout,  except  when  it  affects  the  liver  or 
stomach,  seems  always  to  be  a secondary  disease,  and,  like  the 
rheumatism  and  etvsipelas  mentioned  below,  begins  w ith  the  tor- 
por of  some  distant  part  of  the  system. 

The  most  frequent  primary  seat  of  the  gout  I suppose  to  be 


Class  IV.  1.  2.  15. 


OF  ASSOCIATION. 


m 


the  liver,  which  is  probably  affected  with  torpor  not  only  previ- 
ous to  the  annual  paroxysms  of  the  gout,  but  to  every  change  of 
its  situation  from  one  limb  to  another.  The  reasons,  which  in- 
duce me  to  suspect  the  liver  to  be  first  affected,  are  not  only  be- 
cause the  jaundice  sometimes  attends  the  commencement  of  gout, 
as  described  in  Sect.  XXIV.  2.  8.  but  a pain  also  over  the  pit  of 
the  stomach,  which  I suppose  to  be  of  the  termination  of  the  bile- 
duct  in  the  duodenum,  and  which  is  erroneously  supposed  to  be 
the  gout  of  the  stomach,  with  indigestion  and  flatulency,  gene- 
rally attends  the  commencement  of  the  inflammation  of  each 
limb.  See  Arthritis  ventriculi,  Class  I.  2.  4.  6.  In  the  two 
cases,  which  I saw,  of  the  gout  in  the  limbs  being  preceded  by 
jaundice,  there  was  a cold  shivering  fit  attended  the  inflammation 
of  the  foot,  and  a pain  at  the  pit  of  the  stomach;  which  ceased 
along  with  the  jaundice,  as  soon  as  the  foot  became  inflamed. 
This  led  me  to  suspect,  that  there  was  a torpor  of  the  liver,  and 
perhaps  of  the  foot  also,  but  nevertheless  the  liver  might  also  in 
this  case  be  previously  inflamed,  as  observed  in  Sect.  XXIV.  2.  8. 

Now  as  the  membranes  of  the  joints  of  the  feet  suffer  greater 
variations  of  heat  and  cold  than  the  membranes  of  the  liver,  and 
are  more  habituated  to  extension  and  contraction  than  other  parts 
of  the  skin  in  their  vicinity;  I suppose  them  to  be  more  mobile, 
that  is,  more  liable  to  run  into  extremes  of  exertion  or  quiescence; 
and  are  thence  more  susceptible  of  inflammation,  than  such  parts 
as  are  less  exposed  to  great  variations  of  heat  and  cold,  or  of  ex- 
tension and  contraction. 

When  a stone  presses  into  the  sphincter  of  the  bladder,  the 
glans  penis  is  affected  with  greater  pain  by  sympathy,  owing  to 
its  greater  sensibility,  than  the  sphincter  of  the  bladder;  and  when 
this  pain  commences,  that  of  the  sphincter  ceases,  when  the  stone 
is  not  too  large,  or  pushed  too  far  into  the  urethra.  Thus  when 
the  membrane,  which  covers  the  ball  of  the  great  toe,  sympathizes 
with  some  membranous  part  of  a torpid  or  inflamed  liver;  this 
membrane  of  the  toe  falls  into  that  kind  of  action,  whether  of 
torpor  or  inflammation,  with  greater  energy,  than  those  actions 
excited  in  the  diseased  liver;  and  when  this  new  torpor  or  in- 
flammation commences,  that  with  which  it  sympathizes  ceases; 
which  I believe  to  be  a general  law  of  associated  inflammations. 

The  paroxysms  of  the  gout  would  seem  to  be  catenated  with 
solar  influence,  both  in  respect  to  their  larger  annual  periods,  and 
to  their  diurnal  periods — See  Sect.  XXXVI.  3.  6. — as  the  former 
occur  about  the  same  season  of  the  year,  and  the  latter  com- 
mence about  an  hour  before  sun-rise;  nevertheless,  the  annua! 


580 


DISEASES 


Class  IV.  1.  2.  15. 


periods  may  depend  on  the  succession  of  great  vicissitudes  of 
cold  and  heat,  and  the  diurnal  ones  on  our  increased  sensibility 
to  internal  sensations  during  sleep,  as  in  the  fits  of  asthma,  and 
of  some  epilepsies.  See  Sect.  XVIII.  15. 

In  respect  to  the  pre-remote  cause  or  disposition  to  the  gout, 
there  can  be  no  doubt  of  its  individually  arising  from  the  potation 
of  fermented  or  spirituous  liquors  in  this  country;  whether  opium 
produces  the  same  effect  in  the  countries  where  it  is  in  daily  use, 
I have  never  been  well  informed.  See  Sect.  XXI.  10.  where 
this  subject  is  treated  of;  to  which  I have  to  add,  that  I have 
seen  some,  and  heard  of  others,  who  have  moderated  their  pa- 
roxysms of  gout,  by  diminishing  the  quantity  of  fermented  liquors, 
which  they  had  been  accustomed  to;  and  others  who,  by  a total 
abstinence  from  fermented  liquors,  have  entirely  freed  them- 
selves from  this  excruciating  malady;  which  otherwise  grows 
with  our  years,  and  curtails  or  renders  miserable  the  latter  half, 
or  third,  of  the  lives  of  those  who  are  subject  to  it.  The  remote 
cause  is  whatever  induces  temporary  torpor  or  weakness  of  the 
system;  and  the  proximate  cause  is  the  inirritability,  or  defective 
irritation,  of  some  part  of  the  system;  whence  torpor  and  conse- 
quent inflammation.  The  great  Sydenham  saw7  the  beneficial 
effects  of  the  abstinence  from  fermented  liquors  in  preventing  the 
gout,  and  adds,  “ if  an  empiric  could  give  small-beer  only  to 
“ gouty  patients  as  a nostrum,  and  persuade  them  not  to  drink 
“ any  other  spirituous  fluids,  he  might  rescue  thousands  from  this 
“ disease,  and  acquire  a fortune  for  his  ingenuity.”  Yet  it  is  to 
be  lamented,  that  this  accurate  observer  of  diseases  had  not  reso- 
lution to  practise  his  own  prescription,  and  thus  to  have  set  an 
example  to  the  world  of  the  truth  of  his  doctrine;  but,  on  the 
contrary,  recommended  Madeira,  the  strongest  wine  in  common 
use,  to  be  taken  in  the  fits  of  the  gout,  to  the  detriment  of  thou- 
sands; and  is  said  himself  to  have  perished  a martyr  to  the  dis- 
ease, which  he  knew  how7  to  subdue! 

As  example  has  more  forcible  effect  than  simple  assertion,  I 
shall  now  concisely  relate  my  owrn  case,  and  that  of  one  of  my 
most  respected  friends.  E.  D.  was  about  forty  years  of  age, 
when  he  was  first  seized  with  a fit  of  the  gout.  The  ball  of  his 
right  great  toe  was  very  painful,  and  much  swelled  and  inflam- 
ed, which  continued  five  or  six  days  in  spite  of  venesection,  a 
brisk  cathartic  with  ten  grains  of  calomel,  and  the  application  of 
cold  air  and  cold  water  to  his  foot.  He  then  ceased  to  drink 
ale  or  wine  alone;  confining  himself  to  small-beer,  or  wine  di- 
luted with  about  thrice  its  quantity  of  water.  In  about  a year 
he  suffered  two  other  fits  of  the  gout,  in  less  violent  degree.  He 


Class  IV.  1.  2.  15. 


OF  ASSOCIATION. 


3S1 


then  totally  abstained  from  all  fermented  liquors,  not  even  tasting- 
small -beer,  or  a drop  of  any  kind  of  wine;  but  ate  plentifully  of 
flesh-meat,  and  all  kinds  of  vegetables,  and  fruit,  using  for  his 
drink  at  meals  chiefly  water  alone,  or  lemonade,  or  cream  water; 
with  tea  and  coffee  between  them  as  usual. 

By  this  abstinence  from  fermented  liquors  he  kept  quite  free 
from  the  gout  for  fifteen  or  sixteen  years;  and  then  began  to  take 
small-beer  mixed  with  water  occasionally,  or  wine  and  water,  or 
perry  and  water,  or  cyder  and  water;  by  which  indulgence  after 
a few  months  he  had  again  a paroxysm  of  gout,  which  continued 
about  three  days  in  the  ball  of  his  toe;  which  occasioned  him 
to  return  to  his  habit  of  drinking  water,  and  he  has  now  for 
above  twenty  years  kept  in  perpetual  health,  except  accidental 
colds  from  the  changes  of  the  seasons.  Before  he  abstained 
from  fermented  or  spirituous  liquors,  he  was  frequently  subject 
to  the  piles,  and  to  the  gravel,  neither  of  which  he  has  since  ex- 
perienced. 

In  the  following  case  the  gout  was  established  by  longer  habit 
and  greater  violence,  and  therefore  required  more  cautious  treat- 
ment. The  Rev.  R.  W.  was  seized  with  the  gout  about  the  age 
of  thirty-two,  which  increased  so  rapidly  that  at  the  age  of  forty- 
one  he  was  confined  to  his  room  seven  months  in  that  year;  he 
had  some  degree  of  lameness  during  the  intervals,  with  chalky 
swellings  of  his  heels  and  elbows.  As  the  disease  had  continued 
so  long  and  so  violently,  and  the  powers  of  his  digestion  were 
somewhat  weakened,  he  was  advised  not  entirely  to  leave  off 
all  fermented  liquors;  and  as  small-beer  is  of  such  various 
strength,  he  was  advised  to  drink  exactly  two  wine-glasses,  about 
four  ounces,  of  wine  mixed  with  three  or  four  times  its  quantity 
of  water,  with  or  without  lemon  and  sugar,  for  his  daily  pota- 
tion at  dinner,  and  no  other  fermented  liquor  of  any  kind;  and 
was  advised  to  eat  flesh-meat  with  any  kind  of  boiled  vegetables, 
and  fruit,  with  or  without  spice.  He  has  now  scrupulously  con- 
tinued this  regimen  for  above  five  years,  and  has  had  an  annual 
moderate  gouty  paroxysm  of  a few  wreeks,  instead  of  the  confine- 
ment of  so  many  months,  with  great  health  and  good  spirits 
during  the  intervals. 

The  following  is  a more  particular  account  of  the  history  of 
this  case;  being  part  of  a letter  which  Mr.  Wilmot  wrote  on  that 
subject  at  my  entreaty. 

“ I entered  into  the  army  with  an  excellent  constitution  at 
the  age  of  fifteen.  The  corps  I served  in  was  distinguished  by 
its  regularity,  that  is,  the  regular  allowance  of  the  mess  was  only 
one  pint  of  wine  per  man  each  day;  unless  we  had  company 
to  dine  with  us;  then,  as  was  the  general  custom  of  the  time, 


382 


DISEASES 


Class  IV.  l."2. 15. 


the  bottle  circulated  without  limit.  This  mode  of  living,  though 
by  no  means  considered  as  excess  for  men,  was  certainly  too 
great  for  a youth  of  my  age.  This  style  of  living  I continued, 
when  with  the  regiment,  till  the  latter  end  of  the  year  1769, 
when  I had  the  misfortune  to  sleep  in  a damp  bed  at  Sheffield 
on  a journey  to  York,  but  arrived  there  before  I felt  the  ill  effects 
of  it.  I was  then  seized  with  a violent  inflammatory  rheumatism 
with  great  inflammation  of  my  eyes,  and  was  attended  by  Dr. 
Dealtry;  so  violent  was  the  disorder,  that  I was  bled  for  it  eight 
times  in  less  than  a fortnight;  and  was  three  months,  before  I 
could  consider  my  health  perfectly  re-established.  Dr.  Dealtry 
told  me,  that  I should  be  subject  to  similar  attacks  for  many 
years;  and  that  he  had  no  doubt,  from  the  tendency  he  found  in 
my  habit  to  inflammation,  that,  when  I was  farther  advanced  in 
life,  I should  change  that  complaint  for  the  gout.  He  predicted 
truly;  for  the  three  succeeding  winters  I had  the  same  complaint, 
but  not  so  violently;  the  fourth  winter  I escaped,  and  imputed 
my  escape  to  the  continuance  of  cold  bathing  during  the  whole 
of  that  winter;  after  that  I never  escaped  it,  till  I had  a regular 
and  severe  fit  of  the  gout:  after  the  first  attack  of  rheumatic 
fever  I was  more  abstemious  in  my  manner  of  living,  though 
when  in  company  I never  subjected  myself  to  any  great  re- 
straint. In  the  year  1774  I had  quitted  the  army,  and  being  in 
a more  retired  situation,  was  seldom  led  into  any  excess;  in 
1776  and  1777  I was  in  the  habit  of  drinking  a good  deal  of 
wine  very  frequently,  though  not  constantly.  After  that  period 
till  the  year  1781,  I drank  a larger  quantity  of  wine  regularly, 
but  very  seldom  to  any  degree  of  intoxication.  I lived  much  at 
that  time  in  the  society  of  some  gentlemen,  who  usually  drank 
nearly  a bottle  of  wine  daily  after  dinner.  I must  here  however 
observe,  that  at  no  part  of  my  life  was  I accustomed  to  drink 
wine  in  an  evening,  and  very  seldom  drank  any  thing  more  than 
a single  half-pint  glass  of  some  sort  of  spirits  diluted  with  much 
water.  Till  the  year  1781  I had  always  been  accustomed  to 
use  very  violent  and  continued  exercise  on  horse-back;  in  the 
winter  months  I pursued  all  field  diversions,  and  in  the  summer 
months  I rode  frequent  and  long  journeys;  and  with  this  exercise 
was  liable  to  perspire  to  great  excess;  besides  which  I was  sub- 
ject to  very  profuse  night-sweats,  and  had  frequently  boils  break 
out  all  over  me,  especially  in  the  spring  and  autumn;  for  which 
I took  no  medicine,  except  a little  of  the  flowers  of  sulphur  with 
cream  of  tartar  in  honey. 

“ You  will  observe  I bring  every  thing  down  to  the  date  of 
1781.  In  the  month  of  October  in  that  year,  when  I was  just 
entered  into  the  thirty-second  year  of  my  age,  I had  the  first 


Class  IV.  1.  2.  15. 


OF  ASSOCIATION. 


383 


attack  of  gout;  that  fit  was  very  severe,  and  of  many  weeks  con- 
tinuance. I now  determined  upon  a more  abstemious  method 
of  living,  in  respect  to  wine;  and  indeed  the  society,  in  which 
I had  before  been  accustomed  to  live,  being  considerably  chang- 
ed, I had  less  frequent  temptations  to  excess.  From  this  time  I 
enjoyed  the  most  perfect  good  state  of  health  till  August  1784, 
when  I had  my  second  attack  of  gout.  I never  perfectly  reco- 
vered from  this  attack  through  the  succeeding  winter;  and  in 
March  1785,  was  advised  to  try  the  Bath  waters,  and  drank 
them  under  the  direction  of  one  of  the  faculty  of  that  place. 
I was  there  soon  seized  with  a fever,  and  a slight  attack  of  gout 
in  one  knee.  I should  observe,  that  when  I set  out  from  home, 
I was  in  a weak  and  low  state,  and  unequal  to  much  fatigue;  as 
appeared  by  my  having  a fainting  fit  one  day  on  the  road,  after 
having  travelled  only  about  fifty  miles;  in  the  course  of  the 
summer  I had  two  or  three  more  slight  attacks  of  gout  of  less 
consequence,  till  the  month  of  October;  when  I was  afflicted 
with  it  all  over  me  in  such  a manner,  as  to  be  without  the  possi- 
bility of  the  least  degree  of  removal  for  some  days;  and  was 
about  two  months  without  being  able  to  get  into  the  air.  This 
was  the  severest  attack  I had  then  experienced;  though  I have 
since  had  several  equally  severe.  In  the  course  of  this  summer 
I had  a fall  with  my  horse;  and  soon  after  it,  having  discovered 
an  enlargement  on  one  elbow,  I concluded  I had  hurt  it  at  that 
time;  but  in  the  course  of  this  last  attack  having  a similar  en- 
largement on  the  other  elbow,  I found  my  mistake,  and  that 
they  were  collections  of  gouty  matter;  these  increased  to  the 
size  of  pullet’s  eggs,  and  continue  in  that  state.  I had  soon  af- 
ter similar  enlargements  on  my  heels;  the  right  heel  being  se- 
verely bruised,  I was  under  the  necessity  of  having  it  lanced,  and 
a large  quantity  of  chalky  matter  was  discharged  from  it;  and 
have  since  that  time  frequently  had  chalky  matter  taken  from 
it,  and  sometimus  small  bits  of  apparently  perfect  chalk.  My 
right  hand  was  soon  afflicted  in  the  same  way,  and  I have  scarce- 
ly a joint  on  those  fingers  now  in  a natural  state.  My  left  hand 
has  escaped  tolerably  well.  After  this  last  attack  (viz.  October 
1785)  I had  two  or  three  slight  attacks  before  the  month  of  June 
1787,  when  I had  a very  severe  intermittent  fever;  from  that 
time  I continued  very  well  till  the  latter  end  of  the  year,  when  I 
began  to  feel  the  gout  about  me  very  much,  but  was  not  confin- 
ed by  it.  I was  in  this  state  advised  to  try  what  is  called  the 
American  Recipe  (gum  guaiacum  and  nitre  dissolved  inspirits;) 
it  had  apparently  been  of  essential  service  to  a friend  of  mine, 
who,  from  the  inability  to  walk  a mile  for  some  years,  was  be- 
lieved to  be  restored  by  the  use  of  this  medicine  to  a good  state 


384 


DISEASES 


Class  IV.  1.  2. 15. 


bf  health,  so  as  to  walk  ten  miles  a day.  In  addition  to  this 
medicine  I drank,  as  my  common  beverage  with  my  meals, 
spruce  beer.  I had  so  high  an  opinion  of  this  medicine  in  the 
gout,  and  of  spruce  beer  as  an  antiscorbutic,  that  I contemplated 
with  much  satisfaction,  and  with  very  little  doubt,  the  perfect 
restoration  of  my  health  and  strength;  but  I was  miserably  de- 
ceived; for  in  September  1788  I was  seized  with  the  gout  in  a 
degree  that  none  but  arthritics,  and  indeed  but  few  of  these, 
can  easily  conceive.  From  this  time  till  August  1789  I scarcely 
ever  passed  a comfortable  day;  seven  months  of  this  time  I had 
been  confined,  my  health  seemed  much  impaired,  my  strength 
was  diminished,  and  my  appetite  almost  gone.  In  this  state  my 
friends  pressed  me  to  consult  you.  I was  unwilling  for  some 
time  to  do  it,  as  I had  lost  all  hope  of  relief;  however,  when  I 
had  determined  to  apply  to  you,  I likewise  determined  to  give 
up  every  prejudice  of  my  own  respecting  my  case,  and  to  ad- 
here most  strictly  to  your  advice.  On  the  20th  of  August  1789 
I consulted  you,  on  the  25th  I entered  upon  the  regimen,  which 
you  prescribed,  and  which  w^as  as  follows: 

“ Drink  no  malt  liquor  on  any  account.  Let  your  beverage  at 
“ dinner  consist  of  two  glasses  of  wine  diluted  with  three  half- 
“ pints  of  water.  On  no  account  drink  any  more  wine  or  spiri- 
tuous liquors  in  the  course  of  the  day;  but,  if  you  want  more 
“ liquid,  take  cream  and  water,  or  milk  and  w'ater,  or  lemonade 
“ with  tea,  coffee,  chocolate.  Use  the  warm  bath  twice  a week 
“ for  half  an  hour  before  going  to  bed,  at  the  degree  of  heat 
“ which  is  most  grateful  to  your  sensations.  Eat  meat  constant- 
“ ly  at  dinner,  and  with  any  kind  of  tender  vegetables  you  please. 
“ Keep  the  body  open  by  two  evacuations  daily,  if  possible 
“ without  medicine,  if  not  take  the  size  of  a nutmeg  of  lenitive 
“ electuary  occasionally,  or  five  grains  of  rhubarbs  every  night. 
“ Use  no  violent  exercise,  which  may  subject  yourself  to  sudden 
“ changes  from  heat  to  cold;  but  as  much  moderate  exercise  as 
“ may  be,  without  being  much  fatigued  or  starved  with  cold. 
“ Take  some  supper  every  night;  a small  quantity  of  animal 
“food  is  preferred;  but  if  your  palate  refuses  this,  take  ve- 
getable food,  as  fruit-pie,  or  milk;  something  should  be  eaten, 
“ as  it  might  be  injurious  to  you  to  fast  too  long.”  To  the  whole 
of  this  I adhered  most  scrupulously,  and  soon  found  my  appetite 
improve,  and  with  it  my  strength  and  spirits.  I had  in  Decem- 
ber a severe  attack,  and  two  or  three  slight  ones  in  the  course  of 
twelve  months;  but  the  improvement  in  the  general  state  of  my 
health  induced  me  to  persevere.  On  the  18th  of  August,  1790, 
I had  another  severe  attack,  but  it  went  off  easier  than  before, 
and  I soon  recovered  sufficiently  to  go  to  Buxton,  which  you  ad- 


Class.  IV.  1.  2.  IS. 


of  Association. 


885 


vised  me  to,  and  from  which  I reaped  great  benefit;  nevertheless 
on  the  29th  of  December  I had  a slight  attack  in  comparison  of 
some  that  I had  before  experienced,  and  from  that  time  I was 
free  from  gout,  and  enjoyed  my  health  perfectly  well  till  the 
fourth  week  in  October  1791;  from  that  till  the  third  week  in 
October  1792;  from  that  till  the  third  week  in  October  1793; 
and  from  that  till  June  1794.  From  what  happened  for  the  last 
three  years  I dreaded  the  month  of  October;  but  I escaped  then, 
and  have  enjoyed  my  health  most  perfectly  ever  since  till  within 
the  last  week,  that  1 have  had  a slight  attack  in  one  knee,  which 
is  nearly  gone,  without  any  symptom  to  lead  me  to  suppose  that  it 
will  go  further. 

“ I adhered  to  your  advice  most  scrupulously  for  the  first  year; 
and  in  regard  to  the  not  drinking  malt  liquor,  and  taking  only 
the  two  glasses  of  wine  with  water,  I have  never  deviated  but 
two  days;  and  then  the  first  day  I only  drank  one  glass  of  ale 
and  one  glass  of  champaigne;  on  the  second  only  one  glass  of 
champaigne.  With  regard  to  the  warm  bath,  I only  use  it  now 
when  I have  gouty  symptoms  upon  me,  and  in  such  situations  I 
find  it  of  infinite  service;  and  in  other  respects  I continue  to  live 
according  to  your  direction. 

“ Many  persons  have  laughed  at  the  idea  of  my  perseverance 
in  a system,  which  has  not  been  able  to  cure  the  gout  after  five 
years  trial;  but  such  persons  are  either  ignorant  of  what  I be- 
fore  suffered,  or  totally  unacquainted  with  the  nature  of  the  dis- 
order. Under  the  blessing  of  Providence,  by  an  adherence  to 
your  advice,  I am  reaping  all  the  benefit  you  flattered  me  I 
might  expect  from  it,  viz.  my  attacks  less  frequent,  my  suffer- 
ings less  acute,  and  an  improvement  in  the  general  state  of  my 
health. 

“ I have  been  particular  in  this  account  of  myself  at  your  re- 
quest, and  am,  Sir,  &c. 

“ Morley  near  Derby , “ Robert  Wilmot.” 

Feb.  10th,  1795.” 

There  are  situations  nevertheless,  in  which  a paroxysm  of  gout 
has  been  believed  to  be  desirable,  as  relieving  the  patient  from 
other  disagreeable  diseases,  or  debilities  or  sensations.  Thus 
when  the  liver  is  torpid,  a perpetual  uneasiness  and  depression 
of  spirits  occur;  which  a fit  of  gout  is  supposed  to  cure  by  a 
metastasis  of  the  disease.  Others  have  acquired  epileptic  fits, 
probably  from  the  disagreeable  sensation  of  a chronically  inflam- 
ed liver;  which  they  suppose  the  pain  and  inflammation  of  gout 
would  relieve.  When  gouty  patients  become  much  debiliiated 
by  the  progress  of  the  disease,  they  are  liable  to  dropsy  of  the 

VOL.  ii.  3d 


DISEASES 


Class  IV.  1.  2.  15, 


chest,  which  they  suppose  a fit  of  the  gout  would  relieve.  But 
in  all  these  cases  the  attempt  to  procure  a paroxysm  of  gout  by 
wine  or  aromatics,  or  volatiles,  or  blisters,  or  mineral  waters, 
seldom  succeeds;  and  the  patients  are  obliged  to  apply  to  other 
methods  of  relief  adapted  to  their  particular  cases.  In  the 
two  former  situations  small  repeated  doses  of  calomel,  or  mer- 
curial unction  on  the  region  of  the  liver,  may  succeed,  by  giving 
new  activity  to  the  vessels  of  the  liver,  either  to  secrete  or  to 
absorb  their  adapted  fluids,  and  thus  to  remove  the  cause  of 
the  gout,  rather  than  to  promote  a fit  of  it.  In  the  last  case  the 
tincture  of  digitalis,  and  afterwards  the  class  of  sorbentia,  must 
be  applied  to. 

M.  M.  In  young  strong  patients  the  gout  should  be  cured  by 
venesection  and  cathartics  and  diluents,  with  poultices  exter- 
nally. But  it  has  a natural  crisis  by  producing  calcareous  mat- 
ter on  the  inflamed  membrane,  and  therefore  in  old  enfeebled 
people  it  is  safest  to  wait  for  this  crisis,  attending  to  the  natu- 
ral evacuations  and  the  degree  of  fever;  and  in  young  ones,  where 
it  is  not  attended  with  much  fever,  it  is  customary  and  popu- 
lar not  to  bleed,  but  only  to  keep  the  body  open,  with  aloes,  to 
use  gentle  sudorifics,  as  neutral  salts,  and  to  give  the  bark  at  the 
decline  of  the  fit;  which  is  particularly  useful  where  the  patient 
is  much  debilitated.  See  Arthritis  ventriculi,  Class  I.  2.  4.  6. 
and  Sect.  XXV.  17. 

Mr.  Kelly,  surgeon  in  the  navy,  in  an  ingenious  treatise, 
printed  at  Edinb.  1797,  termed  Observations  on  Compression 
by  the  Tourniquet,  advises  in  both  inflammatory  and  chronic 
rheumatism  to  compress  the  artery  of  the  affected  limb  by  the 
tourniquet,  for  15  or  20  minutes,  relaxing  or  tightening  the 
bandage,  as  the  patient  seems  to  bear  it.  And  in  inflammatory 
rheumatism,  he  advises  to  take  blood  from  a vein  below  the 
bandage,  which  he  says  relieves  the  pain  and  destroys  the  in- 
flammation. Could  not  this  experiment  be  used  safely  in  the 
gout  of  young  or  strong  patients?  and  perhaps  with  speedy 
success? 

When  there  is  not  much  fever,  and  the  patient  is  debilitated 
with  age,  or  the  continuance  of  the  disease,  a moderate  opiate, 
as  twenty  drops  of  tincture  of  opium,  or  one  grain  of  solid  opium, 
may  be  taken  every  night  with  advantage.  Externally  a paste 
made  with  double  the  quantity  of  vest  is  a good  poultice;  and 
booterkins  made  with  oiled  silk,  as  they  confine  the  perspirable 
matter,  keep  the  part  moist  and  supple,  and  thence  relieve  the 
pain  like  poultices. 

The  only  safe  way  of  moderating  the  disease  is  by  an  uniform 
and  equal  diminution,  or  a total  abstinence  from  fermented 


CxassIV.  1.2. 16. 


OF  ASSOCIATION. 


387 


liquors,  with  the  cautions  directed  in  Sect.  XII.  7.  8.  The 
continued  use  of  strong  bitters,  as  of  Portland’s  power,  or  bark, 
has  been  frequently  injurious,  as  spoken  of  in  the  Materia  Me- 
dica,  Art.  IV.  2.  11. 

One  of  my  acquaintance,  who  was  much  afflicted  with  the 
gout,  abstained  for  about  half  a year  from  beer  and  wine;  and 
not  having  resolution  to  persist,  returned  to  his  former  habits  of 
potation  in  less  quantity;  and  observed  that  he  was  then  for  one 
winter  stronger  and  freer  from  the  gout  than  usual.  This  how- 
ever did  not  long  continue,  as  the  disease  afterwards  returned  with 
its  usual  or  increased  violence.  This  I think  is  a circumstance 
not  unlikely  to  occur,  as  opium  has  a greater  effect  after  its  use 
has  been  a while  intermitted;  and  the  debility  or  torpor,  which 
is  the  cause  of  gout,  is  thus  for  a few  months  prevented  by  the 
greater  irritability  of  the  system,  acquired  during  the  lessened 
use  of  fermented  liquor. 

For  the  same  reason  an  ounce  of  spirituous  tincture  of  guaia- 
cum,  or  of  bark,  is  said  to  have  for  some  time  prevented  returns 
of  the  gout;  which  has  afterwards,  like  all  other  great  stimuli 
when  long  continued,  been  succeeded  by  greater  debility,  and 
destroyed  the  patient.  This  seems  to  have  been  exemplified  in 
the  case  of  the  ingenious  Dr.  Brown,  see  Preface  to  his  Ele- 
menta  Medicinae;  he  found  temporary  relief  from  the  stimulus 
of  wine,  regardless  of  its  future  effects. 

Lastly,  as  the  gouty  inflammation,  like  the  rheumatic  swellings 
of  the  wrists  and  ankles,  is  not  a primary  disease;  and  is  like 
them  not  liable  to  suppurate;  there  is  reason  to  believe  that  opi- 
ates may  be  given  with  less  danger  than  in  other  inflammations, 
and  with  a prospect  of  advantage;  since  by  preventing  the  pe- 
riods of  torpor  of  the  liver,  or  other  part  primarily  affected,  the 
diurnal  additional  attack,  or  its  producing  inflammation  of 
another  limb,  may  sometimes  be  prevented.  A person  a few 
days  ago  assured  me,  that  when  the  gout  came  into  his  foot,  his 
practice  was  to  take  thirty  drops  of  tincture  of  opium;  and  in 
half  an  hour  thirty  drops  more;  and  even  a third  dose  if  the 
pain  did  not  subside;  and  that  the  fit  soon  ceased.  I should 
think  this  a dangerous  experiment.  A Mr.  Warner  wrote  a 
book  recommending  opiuYn  in  the  gout,  but  died  soon  after  its 
publication. 

16.  Rheumatismus.  Acute  rheumatism.  There  is  reason  to 
suspect,  that  rheumatic  inflammations,  like  the  gouty  ones,  are 
not  a primary  disease;  but  that  they  are  the  consequence  of  a 
translation  of  morbid  action  from  one  part  of  the  system  to 
another.  This  idea  is  countenanced  by  the  frequent  change  of 
place  of  rheumatic-like  gouty  inflammations,  and  from  their  at- 


m 


DISEASES 


Class  IV.  1.2. 16. 


tacking  two  similar  parts  at  the  same  time,  as  both  ankles  and 
both  wrists,  and  these  attacks  being  in  succession  to  each  other. 
Whereas  it  is  not  probable  that  both  feet  or  both  hands  should 
at  the  same  time  be  equally  exposed  to  any  external  cause  of  the 
disease,  as  to  cold  or  moisture;  and  less  so  that  these  should  oc- 
cur in  succession.  Lastly,  from  the  inflammatory  diathesis  in 
this  disease  being  more  difficult  to  subdue,  and  more  dangerous 
in  event,  than  other  common  inflammations,  especially  to  preg- 
nant women,  and  in  weak  constitutions. 

From  this  idea  of  the  rheumatism  being  not  a primary  dis- 
ease, like  the  gout,  but  a transferred  morbid  action  owing  to  the 
previous  torpor  of  some  other  part  of  the  system,  we  perceive 
why  it  attacks  weak  people  with  greater  pertinacity  than  strong 
ones;  resisting  or  recurring  again  and  again  after  frequent  evacua- 
tions, in  a manner  very  different  from  primary  inflammations; 
because  the  cause  is  not  removed,  which  is  at  a distance  from  the 
seat  of  the  inflammation. 

This  also  accounts  for  rheumatic  inflammations  so  very  rarely 
terminating  in  suppuration,  because  like  the  gout,  the  original 
cause  is  not  in  the  inflamed  part,  and  therefore  does  not  con- 
tinue to  act  after  the  inflammation  commences.  Instead  of  sup- 
puration in  this  disease,  as  well  as  in  the  gout,  a quantity  of 
mucus  or  coagulable  lymph  is  formed  on  the  inflamed  mem- 
brane; which  in  the  gout  changes  into  chalk-stones,  and  in  the 
rheumatism  is  either  reabsorbed,  or  lies  on  the  membrane,  pro- 
ducing pains  on  motion,  long  after  the  termination  of  the  inflam- 
mation, which  pains  are  called  chronic  rheumatism.  The  mem- 
branes which  have  thus  been  once  or  repeatedly  inflamed,  become 
less  mobile,  or  less  liable  to  be  affected  by  sympathy,  as  appears 
by  the  gout  affecting  new  parts,  when  the  joints  of  the  foot  have 
been  frequently  inflamed  by  it;  hence  as  the  cause  of  the  inflam- 
mation does  not  exist  in  the  inflamed  part,  and  as  this  part  be- 
comes less  liable  to  future  attacks,  it  seldom  suppurates. 

Pleurodyne  rheumatica.  When  rheumatism  affects  the  mus- 
cles of  the  chest,  it  produces  symptoms  similar  to  pleurisy,  but 
distinguished  from  it  by  the  patient  having  previously  suffered 
rheumatic  affections  in  other  parts,  and  by  the  pertinacity  or  con- 
tinuance of  the  inflammatory  stale  of  the  patient.  This  should 
be  termed  pleurodyne  rheumatica. 

Enteralgia  rheumatica.  When  rheumatic  inflammation  af- 
fects the  bowels,  it  produces  a disease  very  different  from  en- 
teritis, or  common  inflammation  of  the  bowels,  and  should  be 
termed  enteralgia  rheumatica.  The  pain  is  less  than  in  enteri- 
tis, and  the  disease  of  longer  con'inuance,  with  harder  pulse  and 
the  blood  equally  sizy,  It  is  attended  with  frequent  dejections, 


Class  IV.  1.  2. 16. 


OP  ASSOCIATION. 


389 


with  much  mucus,  and  previous  griping  pains,  but  without  vomit- 
ing; and  differs  perhaps  from  dysentery  from  its  not  being  at- 
tended with  bloody  stools,  and  not  being  infectious. 

Rheumatic  inflammations,  which  I believe  to  arise  from  the 
sympathy  of  the  inflamed  part  with  the  torpor  of  some  distant 
part,  may,  I think,  be  certainly  distinguished  from  those  inflam- 
mations of  the  same  part,  which  have  not  arisen  from  sympathy 
with  the  torpor  of  some  distant  part,  but  where  the  cause  of  the 
inflammation  began  in  the  part  where  the  inflammation  exists, 
by  this  circumstance;  that  in  rheumatic  inflammation  the  hard 
or  sharp  pulse  continues  at  about  118  in  a minute  after  the  pain 
abates  or  ceases.  Whereas  in  the  latter  the  inflammatory  fever 
ceases  along  with  the  pain. 

In  two  cases  of  pain  of  the  side,  and  difficult  respiration, 
which  I esteemed  rheumatic,  as  the  hard  pulse  of  118  with  sized 
blood  continued  after  repeated  venesection,  gentle  cathartics, 
and  mild  antimonials,  I found  ten  drops  of  saturated  tincture  of 
digitalis  given  every  six  hours  appear  to  produce  great  good  effect, 
and  to  abate  and  remove  the  inflammatory  diathesis  in  three  or 
four  days. 

Hence  when  a fever  has  continued  more  than  one  lunar  pe- 
riod, attended  with  a hard  or  sharp  pulse  of  118  or  120  in  a 
minute,  and  is  not  attended  with  cough  or  symptoms  of  absorbed 
matter,  it  may  be  esteemed  of  rheumatic  origin,  though  no  local 
pain  or  inflammation  at  present  exists;  and  this  with  greater  cer- 
tainty, if  pain  had  previously  existed:  for  no  fevers,  except  the 
hectic  fevers  from  absorbed  matter,  and  this  attended  with  in- 
flammatory diathesis,  and  which  may  be  called  rheumatic,  ever 
properly  extend,  I believe,  beyond  one  lunation;  though  symp- 
toms of  debility  may  continue  a while  longer.  This  observation 
is  worth  attending  to  in  practice,  as  it  distinguishes  the  kind  of 
fever,  in  which,  when  the  bark  is  erroneously  given,  it  does  no 
service,  and  in  which  I believe  saturated  tincture  of  digitalis  given 
as  above  to  be  the  most  efficacious  medicine. 

Rheumatismus  suppurans.  There  is  another  kind  of  rheuma- 
tism attended  with  debility,  which  suppurates  and  should  be 
termed  rheumatismus  suppurans.  It  is  generally  believed  to  be 
the  gout,  till  suppuration  takes  place  on  the  swelled  joint;  and, 
as  the  patient  sinks,  there  are  sloughs  formed  over  the  whole 
mouth;  and  he  seems  to  be  destroyed  by  inflammation  or  gan- 
grene of  the  mucous  membranes.  I have  twice  seen  this  dis- 
ease in  patients  about  sixty.  Some  other  diseases  are  errone- 
ously called  rheumatic,  as  hemicrania,  and  odontalgia.  See  Sect. 
XXVI.  3. 

• M.  M.  In  the  three  former  kinds  venesection  repeatedly.  Ca- 


390 


DISEASES 


Class  IV.  1.2. 16. 


thartics.  Antimonials.  Diluents.  Neutral  salts.  Oil.  Warm 
bath.  Afterwards  the  bark.  Opium  with  or  without  ipecacu- 
anha; but  not  till  the  patient  is  considerably  weakened.  Sweats 
forced  early  in  the  disease  do  injury.  Opium  given  early  in  the 
disease  prolongs  it.  In  the  last  kind,  gentle  stimulants,  as  wine 
and  water,  mucilage,  sorbentia. 

In  acute  rheumatism,  when  the  swelling  of  the  joints  first  af- 
fected subsides,  a return  of  torpor  in  the  part  primarily  diseased 
commences  previous  to  an  inflammation  of  the  joints  secondarily 
affected.  Hence  when  the  tumour  of  the  joints  first  affected 
subsides,  half  a grain  of  opium,  every  night,  and  Peruvian  bark, 
or  other  bitter  medicine,  may  be  given  to  prevent  this  return  of 
torpor  with  great  advantage;  if  the  patient  has  previously  been 
properly  evacuated,  and  is  not  now  too  much  inflamed. 

Dr.  Fordyce  asserts,  that  when  it  was  the  practice  to  bleed 
largely  in  acute  rheumatism,  a metastasis  frequently  took  place 
to  the  interior  parts  of  the  body,  and  destroyed  the  patient.  And 
adds,  that  during  the  last  fifteen  years  of  his  practice  this  has 
rarely  happened,  as  he  has  entirely  left  off  bleeding  in  the  acute 
rheumatism.  Third  Dissertation  on  Fever  by  G.  Fordyce,  M.  D. 
London,  Johnson.  On  this  subject  it  may  be  remarked,  that  as 
rheumatism  like  gout  is  a secondary  disease,  the  inflammation 
of  one  part  being  symptomatic,  the  seat  of  torpor  existing  in 
some  other  part,  it  may  not  be  so  constantly  necessary  tu  bleed 
so  copiously  in  those  secondary  inflammatory  diseases,  as  in  those 
primary  ones,  where  the  inflamed  part  was  previously  the  seat 
of  torpor,  as  in  pleurisy,  peripneumony,  and  enteritis;  but  in 
rheumatism,  as  well  as  in  erysipelas,  l am  convinced,  that  where 
the  inflammation  of  the  system  is  great,  repeated  venesection  is 
not  only  useful;  but  that  those  who  perish  by  either  -of  those 
diseases,  perish  for  the  want  of  venesection  early,  where  the  at- 
tack is  violent.  And  lastly,  that  even  in  the  gout  of  young  and 
strong  subjects,  as  I know  by  experience  on  myself,  a moderate 
venesection  shortens  the  fit,  and  lessens,  I believe,  the  hazard  of 
metastasis. 

The  following  is  a case  of  suppurative  rheumatism.  Mr. 

F , about  sixty,  was  supposed  to  have  the  gout  in  his  hand, 

which  however  suppurated,  and  it  was  then  called  the  suppura- 
tive rheumatism.  He  had  lived  rather  intemperately  in  respect 
to  wine,  and  was  now  afflicted  with  a tendency  to  inflammation 
of  the  mucous  membranes.  As  he  lay  on  the  bed  half  resupine, 
propped  up  with  pillows,  and  also  slept  in  that  posture,  his  lower 
jaw  dropped  by  its  own  weight,  when  the  voluntary  power  of 
the  muscles  was  suspended.  The  mucus  of  his  mouth  and 
throat  became  quite  dry,  and  at  length  was  succeeded  by  sloughs; 


Class  IV,  1.  2.  17. 


OF  ASSOCIATION. 


391 


this  was  a most  distressing  circumstance  to  him,  and  was  in  vain 
endeavoured  to  be  relieved  by  supporting  his  jaw  by  slender  steel 
springs  fixed  to  his  nightcap,  and  by  springs  of  elastic  gum.  The 
sloughs  spread  and  seemed  to  accelerate  his  death.  See  Class  I. 
1.  3.  2. 

In  acute  rheumatism  Mr.  Kellie  asserts  that  he  has  had  great 
success  by  putting  a tourniquet  on  the  affected  limb,  so  as  to 
compress  the  artery,  and  then  by  taking  blood  from  a vein  below 
the  bandage  as  mentioned  above  in  Podagra.  Class  IV.  1.2.  15. 

17.  E't'ysipelas.  The  erysipelas  differs  from  the  zona  ignea, 
and  other  species  of  herpes,  in  its  being  attended  with  fever, 
which  is  sometimes  of  the  sensitive  irritated  or  inflammatory 
kind,  with  strong  and  full  pulse;  and  at  other  times  with  weak 
pulse  and  great  inirritability,  as  when  it  precedes  or  attends  mor- 
tifications. See  Class  II.  I.  3.  2. 

Like  the  zona  ignea  above  described,  it  seems  to  be  a secon- 
dary disease,  having  for  its  primary  part  the  torpor  or  inflamma- 
tion of  some  internal  or  distant  membrane,  as  appears  from  its 
so  frequently  attending  wounds;  sometimes  spreading  from  is- 
sues over  the  whole  limb,  or  back,  by  sympathy  with  a tendon 
or  membrane,  which  is  stimulated  by  the  peas  in  them.  In 
its  more  violent  degree  I suppose  that  it  sympathizes  with  some 
extensive  internal  membranes,  as  of  the  liver,  stomach,  or  brain. 
Another  reason  which  countenances  this  idea  is,  that  the  inflam- 
mation gradually  changes  its  situation,  one  part  healing  as  another 
inflames;  as  happens  in  respect  to  more  distant  parts  in  gout 
and  rheumatism;  and  which  seems  to  shew,  that  the  cause  of  the 
disease  is  not  in  the  same  place  with  the  inflammation.  And 
thirdly,  because  the  erysipelas  of  the  face  and  head  is  liable  to 
affect  the  membranes  of  the  brain;  which  were  probably  in  these 
cases  the  original  or  primary  seat  of  the  disease;  and  lastly,, 
because  the  fits  of  erysipelas,  like  those  of  the  gout,  are  liable 
to  return  at  certain  annual  or  monthly  periods,’ as  further  treated 
of  in  Class  II.  1 . 3.  2. 

Many  cases  of  erysipelas  from  wounds  or  bruises  are  related  in 
Desault’s  Surgical  Journal,  Vol.  II.  in  which  poultices  are  said 
to  do  great  injury,  as  well  as  oily  or  fatty  applications.  Satur- 
nine solutions  were  sometimes  used  with  advantage.  A grain  of 
emetic  tartar  given  to  clear  the  stomach  and  bowels,  is  said  to  be 
of  great  service. 

18.  Testium  tumor  in  gonorrhoea.  Mr.  Hunter  in  his  Treatise 
on  the  Venereal  Disease  observes,  thac  the  tumor  of  the  testes  in 
gonorrhoea  arises  from  their  sympathy  with  the  inflammation  of 
the  urethra;  and  that  they  are  not  similar  to  the  actions  arising 
from  the  application  of  venereal  matter,  whether  by  absorption  or 


392 


DISEASES 


Class  IV.  I 2.  19. 


otherwise;  as  they  seldom  or  never  suppurate;  and  when  suppu- 
ration happens,  the  matter  produced  is  not  venereal.  Treatise 
on  Venereal  Disease,  p.  53. 

1 9.  Testium  tumor  in  parotidite.  The  sympathy  between  some 
parts  about  the  throat  and  the  genitals  has  been  treated  of  in 
Class  IV.  1.  2.  7.  The  swelling  of  the  testes,  when  that  of  the 
parotis  subsides,  seems  to  arise  from  the  association  of  successive 
action;  as  the  tension  of  the  penis  in  hydrophobia  appears  to 
arise  from  the  previous  synchronous  associations  of  the  sensitive 
motions  of  these  parts,  but  the  manner  of  the  production  of  both 
these  associations  is  yet  very  obscure.  In  women  a swelling  of 
the  breasts  often  succeeds  the  decline  of  the  mumps  by  another 
wonderful  sympathy.  See  Class  IV.  1.  2.  7.  and  I.  1.  2.  15. 
In  many  persons  a delirium  succeeds  the  swelling  of  the  parotis, 
or  the  subsequent  ones  of  the  testes  or  breasts;  which  is  some- 
times fatal,  and  seems  to  arise  from  a sympathy  of  successive  ac- 
tion, and  not  of  synchronous  action,  of  the  membranes  of  the 
brain  with  those  of  the  parotid  glands.  Sometimes  a stupor 
comes  on  instead  of  this  delirium,  which  is  relieved  by  fomenting 
the  shaved  head  for  an  hour  or  two.  SeeClassII.  1.  3.  4. 


C iass  IV.  1.3.1. 


OF  ASSOCIATION-. 


393 


ORDO  I. 

Increased  Associate  Motions. 

GENUS  III. 

Catenated  with  Voluntary  Motions. 

SPECIES. 

1.  Deglutitio  invita.  When  any  one  is  told  not  to  swallow  his 
saliva,  and  that  especially  if  his  throat  be  a little  sore,  he  finds  a 
necessity  of  immediately  swallowing  it;  and  this  the  more  cer- 
tainly, the  more  he  voluntarily  endeavours  not  to  do  so. 

In  this  case  the  voluntary  power  exerted  by  our  attention  to  the 
pharynx  renders  it  more  sensible  to  irritation,  and  therefore  occa- 
sions it  to  be  more  frequently  induced  to  swallow  the  saliva. 
Here  the  irritation  induces  a volition  to  swallow  it,  which  is 
more  powerful  than  the  desire  not  to  swallow  it.  See  Sect. 
XXIV.  1.7.  So  in  reverie,  when  the  voluntary  power  was  ex- 
erted on  any  of  the  senses,  as  of  sight  or  taste,  the  objects  of  those 
senses  became  perceived;  but  not  otherwise.  See  Sect.  XIX. 
6.  This  is  a troublesome  symptom  in  some  sore  throats. 

M.  M.  Mucilage,  as  sugar  and  gum  arabic. 

Warm  water  held  in  the  mouth  frequently,  as  a fomentation  to 
the  inflamed  throat. 

2.  J\fictitatio  invita.  Involuntary  winking  with  the  eye-lids, 
and  twitchings  of  the  face,  are  originally  induced  by  an  endea- 
vour to  relieve  some  disagreeable  sensations  about  inflamed  eyes, 
as  the  dazzling  of  light;  and  afterwards  these  motions  become 
catenated  with  other  motions  or  sensations,  so  as  not  to  be  go- 
verned by  the  will.  Here  the  irritation  first  produces  a volition 
to  wink,  which  by  habit  becomes  stronger  than  the  anti-volition 
not  to  wink. 

This  subject  is  rendered  difficult  from  the  common  acceptation 
of  the  word  volition,  including  previous  deliberation,  as  well  as 
the  voluntary  exertion,  which  succeeds  it.  In  the  volitions  here 
spoken  of,  there  is  no  time  for  deliberation  or  choice  of  objects, 
but  the  voluntary  act  immediately  succeeds  the  sensation  which 
excites  it. 

M.  M.  Cover  the  affected  parts  with  a sticking  plaster  or  a 
blister.  Pass  a fine  needle  and  thread  through  a part  of  the  skin 
over  the  muscle,  which  moves,  and  attach  the  other  end  of  the 
thread  by  a sticking  plaster  to  a distant  part.  An  issue  behind 

VOL.  n.  3e 


391 


DISEASES 


Glass  IV.  1.  3.  3. 


the  ear.  To  practise  daily  by  a looking-glass  to  stop  the  motions 
with  the  hand.  See  the  cure  of  a case  of  the  leaping  of  a muscle 
of  the  arm,  Sect.  XVII.  1.  8.  See  Convulsio  debilis.  Class  III. 
1.  1.  5.  Frequent  electric  sparks,  or  very  slight  shocks. 

3.  Risus  invitus.  Involuntary  laughter.  When  the  pleasure 
arising  from  new  combinations  of  words  and  ideas,  as  in  puns;  or 
of  other  circumstances,  which  are  so  trivial,  as  to  induce  no  vo- 
luntary exertion  to  compare  or  consider  their  present  importance 
or  their  future  consequence;  the  pleasure  is  liable  to  rise  into 
pain;  that  is,  the  ideas  or  sensual  motions  become  exerted  too 
violently  for  want  of  some  antilhesistic  ideas;  in  the  same  manner 
as  those  muscles  which  have  weak  antagonists,  as  those  of  the  calf 
of  the  leg,  are  liable  to  fall  into  cramp  or  painful  contraction.  In 
this  situation,  a scream  is  begun  to  relieve  this  pain  of  ideas  too 
violently  exerted,  which  is  stopped  again  soon,  as  explained  in 
Sect.  XXXIV.  1.  4.  and  Class  III.  1.1.4.  and  IV.  2.  3.  3. 

The  pain  into  which  this  pleasure  rises,  which  would  excite  the 
scream  of  laughter,  has  been  felt  forcibly  by  every  one;  when 
they  have  been  under  such  circumstances,  as  have  induced  them 
to  restrain  it  by  a counter- volition;  till  at  length  the  increased 
associate  motions  produce  so  much  pain  as  to  overcome  the  coun- 
ter-volition, and  the  patient  bursts  out  into  indecent  laughter,  con- 
trary to  his  will  in  the  common  acceptation  of  that  word. 

4.  Lusus  digitorum  invitus.  An  awkward  playing  with  the 
fingers  in  speaking  in  public.  These  habits  are  begun  through 
bashfulness,  and  seem  rather  at  first  designed  to  engage  the  at- 
tention in  part,  and  thus  prevent  the  disagreeable  ideas  of  mau- 
vaise  honte;  as  timorous  boys  whistle,  when  they  are  obliged  to 
walk  in  the  dark;  and  as  it  is  sometimes  necessary  to  employ 
raw  soldiers  in  perpetual  manoeuvres,  as  they  advance  to  the  first 
charge. 

5.  Unguium  morsiuncula  invita.  Biting  the  nails  is  a depraved 
habit,  arising  from  similar  causes  as  those  of  the  last  article. 

M.  M.  Dip  the  fingers  in  solution  of  aloes. 

6.  Vigilia  invita.  Watchfulness,  where  the  person  wishes 
and  endeavours  to  fall  asleep,  properly  belongs  to  this  place,  as 
the  wish  or  volition  to  sleep  prevents  the  desired  effect;  because 
sleep  consists  in  an  abolition  of  volition.  See  Class  III.  1. 2.  3. 


Glass  IV.  1.  4.  1. 


OF  ASSOCIATION. 


395 


ORDO  I. 

Increased  Associate  Motions. 

GENUS  IV. 

Catenated  with  External  Influences. 

SPECIES. 

1 . Vita  ovi.  Life  of  an  egg.  The  eggs  of  fowls  were  shewn 
bj  Mr.  J.  Hunter  to  resist  the  freezing  process  in  their  living 
state  more  powerfully  than  when  they  were  killed  by  having  the 
yolk  and  white  shook  together.  Philos.  Trans.  It  may  be  ask- 
ed, does  the  heat  during  the  incubation  of  eggs  act  as  a stimulus 
exciting  the  living  principle  into  activity?  Or  does  it  act  sim- 
ply as  a causa  sine  qua  non,  as  an  influence,  which  penetrating 
the  mass,  removes  the  particles  of  it  to  a greater  distance  from 
each  other,  so  as  to  allow  their  movement  over  each  other,  in  the 
same  manner  as  heat  is  conceived  to  produce  the  fluidity  of  wa- 
ter; not  by  stimulus,  but  by  its  penetrating  influence?  Or  may 
elementary  heat  in  its  uncombined  state  be  supposed  to  act  only 
as  an  influence  necessary  to  life  in  its  natural  quantity;  whence 
torpor  and  death  follow  the  eduction  of  it  from  the  body;  but 
in  its  increased  state  above  what  is  natural,  or  usual,  that  it  acts 
as  a stimulus;  which  we  have  a sense  to  perceive;  and  which 
excites  many  parts  of  the  system  into  unnatural  action?  See 
Class  IV.  1.  1.  C. 

2.  Vita  liiemi-dormientium.  The  torpor  of  insects,  and  birds, 
and  quadrupeds,  during  the  cold  season,  has  been  called  sleep; 
but  1 suppose  it  must  differ  very  much  from  that  state  of  animal 
life,  since  not  only  all  voluntary  power  is  suspended,  but  sensa- 
tion and  vascular  motion  have  ceased,  and  can  only  be  restored 
by  the  influence  of  heat.  There  have  been  related  instances  of 
snails,  which  have  recovered  life  and  motion  on  being  put  into 
water  after  having  experienced  many  years  of  torpidity,  or  ap- 
parent death,  in  the  cabinets  of  the  curious.  Here  the  water  as 
wrell  as  the  heat  are  required  not  only  as  a stimulus,  but  as  a 
causa  sine  qua  non  of  fluidity  and  motion,  and  consequent  life. 

3.  Pullulatio  arborum.  The  annual  revivescence  of  the  buds 
of  trees  seems  not  only  to  be  owing  to  the  influence  of  the  re- 
turning warmth  of  the  spring,  but  also  to  be  catenated  with  so- 
lar gravitation;  because  seeds  and  roots  and  buds,  which  are 
analogous  to  the  eggs  of  animals,  put  forth  their  shoots  by  a less 


396 


DISEASES 


Class  IV.  1.  4.  4. 


quantity  of  heat  in  spring,  than  they  had  undergone  in  the  lat- 
ter part  of  autumn,  which  may  however  be  ascribed  to  their 
previous  torpid  state,  and  consequent  accumulation  of  sensorial 
power  or  irritability;  as  explained  in  Botanic  Garden,  Part  II. 
Canto  I.  1.  322.  note.  Other  circumstances,  which  counte- 
nance the  idea,  that  vegetation  is  affected  by  solar  gravitation,  as 
well  as  by  heat,  may  be  observed  in  the  ripening  of  the  seeds  of 
plants  both  in  those  countries  where  the  summers  are  short, 
and  in  those  where  they  are  long.  And  by  some  flowers  closing 
their  bells  at  noon,  or  soon  after;  and  hence  seem  to  sleep 
rather  at  solar  diurnal  periods,  than  from  the  influence  of  cold, 
or  the  deficiency  of  light. 

4.  Orgasmatis  vcnerei  periodus.  The  venereal  orgasm  of  birds 
and  quadrupeds  commences  or  returns  about  the  vernal  or  au- 
tumnal ecjuinoxes,  and  thence  seems  in  respect  to  their  great 
periods  to  be  governed  by  solar  influence.  But  if  this  orgasm 
be  disappointed  of  its  object,  it  is  said  to  recur  at  about  monthly 
periods,  as  observed  in  mares  and  bitches,  in  this  respect  re- 
sembling the  female  catamenia.  See  Sect.  XXXVI.  2.  3.  and 
Sect.  XVI.  13. 

5.  Brachii  concussio  declr%ca.  The  movement  of  the  arm, 
even  of  a paralytic  patient,  when  an  electric  shock  is  passed 
through  it,  is  owing  to  the  stimulus  of  the  excess  of  electricity. 
When  a piece  of  zinc  and  another  of  silver,  each  about  the  size 
of  a crown-piece,  are  placed  one  under  the  upper  lip,  and  the 
other  on  the  tongue,  so  as  the  outer  edges  may  be  brought  into 
contact,  there  is  an  appearance  of  light  in  the  eyes,  as  often  as 
the  outer  edges  of  these  metals  are  brought  into  contact  or  sepa- 
rated; which  is  another  instance  of  the  stimulus  of  the  passage 
of  electric  shocks  through  the  fibres  of  the  organs  of  sense,  as 
well  as  through  the  muscular  fibres.  See  Sect.  XII.  1.  1.  But 
in  its  natural  state  electricity  seems  only  to  act  as  an  influence 
on  animal  and  vegetable  bodies;  of  the  salutary  or  injurious  ef- 
fects of  which  we  have  yet  no  precise  knowledge. 

Yet  if  regular  journals  were  kept  of  the  variations  of  atmo- 
spheric electricity,  it  is  probable  some  discoveries  of  its  influence 
on  our  system  might  in  time  be  discovered.  For  this  purpose  a 
machine  on  the  principle  of  Mr.  Bennet’s  electric  doubler  might 
be  applied  to  the  pendulum  of  a clock,  so  as  to  manifest  and 
even  to  record  the  daily  or  hourly  variations  of  aerial  electricity. 
Which  has  already  been  executed,  and  applied  to  the  pendu- 
lum of  a Dutch  wooden  clock,  by  Mr.  Benuet,  curate  ofWirks- 
worth  in  Derbyshire. 

Besides  the  variations  of  the  degree  or  kind  of  atmospheric 
electricity,  some  animals,  and  some  men,  seem  to  possess  a greater 


Class  IV.  1.  4.  6. 


OF  ASSOCIATION. 


397 


power  of  accumulating  this  fluid  in  themselves  than  others.  Of 
which  a famous  history  of  a Russian  prince  was  lately  published; 
who,  during  the  clear  and  severe  frosts  of  that  country,  could  not 
move  himself  in  bed  without  luminous  corruscations.  Such 
may  have  been  the  case  of  those  people,  who  have  been  related 
to  have  taken  fire  spontaneously,  and  to  have  been  reduced  to 
ashes.  The  electric  concussion  from  the  gymnotus  electricus,  and 
torpedo,  are  other  instances  of  the  power  of  the  animal  system  to 
accumulate  electricity,  as  in  these  it  is  used  as  a weapon  of  de- 
fence, or  for  the  purpose  of  taking  their  prey.' 

Some  have  believed  that  the  accumulation  or  passage  of  the 
magnetic  fluid  might  affect  the  animal  system,  and  have  asserted 
that  the  application  of  a large  magnet  to  an  aching  tooth  has 
quickly  effected  a cure.  If  this  experiment  is  again  tried  in 
odontalgia,  or  hemicrania,  the  painful  membrane  of  the  tooth 
or  head  should  be  included  between  the  south  and  north  poles  of 
a horse-shoe  magnet,  or  between  the  contrary  poles  of  two  dif- 
ferent magnets,  that  the  magnetism  may  be  accumulated  on  the 
torpid  part. 

6.  Oxygenatio  sanguinis.  The  variation  of  the  quantity  of 
oxygen  gas  existing  in  the  atmosphere  must  affect  all  breathing 
animals;  in  its  excess  this  too  must  be  esteemed  a stimulus;  but 
in  its  natural  quantity  would  seem  to  act  as  an  influence,  or  cause, 
without  which  animal  life  cannot  exist  even  a minute.  It  is 
hoped  that  Dr.  Beddoes’s  plan  for  a pneumatic  infirmary,  for  the 
purpose  of  putting  this  and  various  other  airs  to  the  test  of  ex- 
periment, will  meet  with  public  encouragement,  and  render  con- 
sumption, asthma,  cancer,  and  many  diseases  conquerable,  which 
at  present  prey  with  unremitted  devastation  on  all  orders  and  ages 
of  mankind. 

7.  Humectatio  corporis.  Water,  and  probably  the  vapour  of 
water  dissolved  or  diffused  in  the  atmosphere,  unites  by  mechani- 
cal attraction  with  the  unorganized  cuticle,  and  softens  and  en- 
larges it;  as  may  be  seen  in  the  loose  and  wrinkled  skin  of  the 
hands  of  washerwomen;  the  same  probably  occurs  to  the  mucous 
membrane  of  the  lungs  in  moist  weather;  and  by  thickening  it 
increases  the  difficulty  of  respiration  of  some  people,  who  are 
said  to  be  asthmatical.  So  far  water  may  be  said  to  act  as  an 
influx  or  influence,  but  when  it  is  taken  up  by  the  mouths  of  the 
absorbent  system,  it  must  excite  those  mouths  into  action,  and 
then  acts  as  a stimulus. 

There  appears  from  hence  to  be  four  methods  by  which  ani- 
mal bodies  are  penetrated  by  external  things.  1.  By  their  stimu- 
lus, which  induces  the  absorbent  vessels  to  imbibe  them.  2.  By 
mechanical  attraction,  as  when  water  softens  the  cuticle.  3.  By 


398 


DISEASES 


Class  IV.  1.  4.  7. 


chemical  attraction,  as  when  oxygen  passes  through  the  mem- 
branes of  the  air-vessels  of  the  lungs,  and  combines  with  the 
blood.  And  lastly,  by  influx  without  mechanical  attraction, 
chemical  combination,  or  animal  absorption,  as  the  universal 
fluids  of  heat,  gravitation,  electricity,  magnetism,  and  perhaps  o! 
other  ethereal  fluids  yet  unknown. 


Class  IV.  2. 1. 


OF  ASSOCIATION. 


39D 


ORDO  II. 

Decreased  Associate  Motions. 

GENUS  I. 

Catenated  with  Irritative  Motions. 

As  irritative  muscular  motions  are  attended  with  pain,  when 
they  are  exerted  too  weakly,  as  well  as  when  they  are  exerted 
too  strongly;  so  irritative  ideas  become  attended  with  sensation 
when  they  are  exerted  too  weakly,  as  well  as  when  they  are  ex- 
erted too  strongly.  Which  accounts  for  these  ideas  being  at- 
tended with  sensation  in  the  various  kinds  of  vertigo  described 
below. 

There  is  great  difficulty  in  tracing  the  immediate  cause  of  the 
deficiencies  of  action  of  some  links  of  the  associations  of  irrita- 
tive motions;  first,  because  the  trains  and  tribes  of  motions, 
which  compose  these  links,  are  so  widely  extended  as  to  embrace 
almost  the  whole  animal  system;  and  secondly,  because  when 
the  first  link  of  an  associated  train  of  actions  is  exerted  with  too 
great  energy,  the  second  link  by  reverse  sympathy  may  be  affected 
with  torpor.  And  then  this  second  link  may  transmit,  as  it  were, 
this  torpor  to  a third  link,  and  at  the  same  time  regain  its  own 
energy  of  action;  and  it  is  possible  this  third  link  may  in  like 
manner  transmit  its  torpor  to  a fourth,  and  thus  regain  its  own 
natural  quantity  of  motion. 

I shall  endeavour  to  explain  this  by  an  example  taken  from 
sensitive  associated  motions,  as  the  origin  of  their  disturbed  ac- 
tions is  more  easily  detected.  This  morning  I saw  an  elderly 
person,  who  had  gradually  lost  all  the  teeth  in  his  upper  jaw, 
and  all  of  the  under  except  three  of  the  molares;  the  last  of 
these  was  now  loose,  and  occasionally  painful;  the  fangs  of 
which  were  almost  naked,  the  gums  being  much  wasted  both 
within  and  without  the  jaw.  He  is  a man  of  attentive  obser- 
vation, and  assured  me,  that  he  had  again  and  again  noticed, 
that,  when  a pain  commenced  in  the  membranes  of  the  alveolar 
process  of  the  upper  jaw,  opposite  to  the  loose  tooth  in  the  under 
one,  (which  had  frequently  occurred  for  several  days  past,)  the 
pain  of  the  loose  tooth  ceased.  And  that,  when  the  pain  after- 
wards extended  to  the  ear  and  temple  on  that  side,  the  pain  in 
the  membranes  of  the  upper  jaw  ceased.  In  this  case  the  mem- 
branes of  the  alveolar  process  of  the  upper  jaw  became  torpid, 
and  consequently  painful,  by  their  reverse  sympathy  with  the 


400 


DISEASES 


Class  IV.  2.  1.  1. 


too  violent  actions  of  the  inflamed  membranes  of  the  loose  tooth; 
and  then  by  a secondary  sympathy  the  membranes  about  the 
ear  and  temple  became  torpid,  and  painful;  and  those  of  the 
alveolar  process  of  the  upper  jaw  regained  their  natural  quantity 
of  action,  and  ceased  to  be  painful.  A great  many  more  nice 
and  attentive  observations  are  wanted  to  elucidate  these  curious 
circumstances  of  association,  which  will  be  found  to  be  of  the 
greatest  importance  in  the  cure  of  many  diseases,  and  lead  us  to 
the  knowledge  of  fever. 

SPECIES. 

1.  Cutis  frigida  pransorum.  Chilness  after  dinner  frequently 
attends  tveak  people,  or  those  who  have  been  exhausted  by  exer- 
cise; it  arises  from  the  great  expenditure  of  the  sensorial  power 
on  the  organs  of  digestion,  which  are  stimulated  into  violent  ac- 
tion by  the  aliment;  and  the  vessels  of  the  skin,  which  are  asso- 
ciated with  them,  become  in  some  measure  torpid  by  reverse 
sympathy;  and  a consequent  chilness  succeeds  with  less  absorp- 
tion of  atmospheric  moisture.  See  the  subsequent  article. 

2.  Pallor  urines  pransorum.  The  paleness  of  urine  after  a 
full  meal  is  an  instance  of  reverse  association;  where  the  second- 
ary part  of  a train  of  associate  motions  acts  with  less  energy  in 
consequence  of  the  greater  exertions  of  the  primary  part.  After 
dinner  the  absorbent  vessels  of  the  stomach  and  intestines  are 
stimulated  into  greater  action,  and  drink  up  the  newly  taken  ali- 
ment; while  those,  which  are  spread  in  great  number  on  the 
neck  of  the  bladder,  absorb  less  of  the  aqueous  part  of  the  urine 
than  usual,  which  is  therefore  discharged  in  a more  dilute  slate; 
and  has  been  termed  crude  by  some  medical  writers,  but  it  only 
indicates,  that  so  great  a proportion  of  the  sensorial  power  is  ex- 
pended on  digestion  and  absorption  of  the  aliment,  that  other 
parts  of  the  system  act  for  a time  with  less  energy.  See  Class 
IV.  1.  1.  6. 

3.  Pallor  urince  afrigore  cutaneo.  There  is  a temporary  dis- 
charge of  pale  water,  and  a diarrhoea,  induced  by  exposing  the 
skin  to  the  cold  air;  as  is  experienced  by  boys,  who  strip  them- 
selves before  bathing.  In  this  case  the  mouths  of  the  cutaneous 
lymphatics  become  torpid  by  the  subduction  of  their  accustom- 
ed degree  of  heat,  and  those  of  the  bladder  and  intestines  be- 
come torpid  by  direct  sympathy;  whence  less  of  the  thinner  part 
of  the  urinary  secretion,  and  of  the  mucus  of  the  intestines,  is 
reabsorbed.  See  Sect.  XXIX.  4.  6.  This  effect  of  suddenly 
cooling  the  skin  by  the  aspersion  of  cold  wrater  has  been  used 
with  success  in  costiveness,  and  has  produced  evacuations,  when 


CUSS  IV.  2.1.4. 


OF  ASSOCIATION. 


401 


other  means  have  failed.  When  young  infants  are  afflicted  with 
griping  joined  with  costiveness,  I have  sometimes  directed  them 
to  be  taken  out  of  a warm  bed,  and  carried  about  for  a few 
minutes  in  a cool  room,  with  almost  instant  relief. 

4.  Pallor  ex  mgritudine.  When  sickness  of  stomach  first  oc- 
curs, a paleness  of  the  skin  attends  it;  which  is  owing  to  the 
association  or  catenation  between  the  capillaries  of  the  stomach 
and  the  cutaneous  ones;  which  at  first  act  by  direct  sympathy. 
But  in  a short  time  there  commences  an  accumulation  of  the 
sensorial  power  of  association  in  the  cutaneous  capillaries  during 
their  state  of  inactivity,  and  then  the  skin  begins  to  glow,  and 
sweats  break  out,  from  the  increased  actions  of  the  cutaneous 
glands  or  capillaries,  which  are  now  in  reverse  sympathy  with 
those  of  the  stomach.  So  in  continued  fevers,  when  the  sto- 
mach is  totally  torpid,  which  is  known  by  the  total  aversion  to 
solid  food,  the  cutaneous  capillaries  are  by  reverse  sympathy  in 
a perpetual  state  of  increased  activity,  as  appears  from  the  heat 
of  the  skin. 

5.  Dyspnoea  a balneo  frigido.  The  difficulty  of  breathing  on 
going  up  to  the  middle  in  cold  water,  is  owing  to  the  irritative 
association  or  catenation  of  the  action  of  the  extreme  vessels  of 
the  lungs  with  those  of  the  skin.  So  that  when  the  latter  are 
rendered  torpid  or  inactive  by  the  application  of  sudden  cold, 
the  former  become  inactive  at  the  same  time,  and  retard  the 
circulation  of  the  blood  through  the  lungs;  for  this  difficulty  of 
breathing  cannot  be  owing  to  the  pressure  of  the  water  imped- 
ing the  circulation  downwards,  as  it  happens  equally  by  a cold 
shower-bath,  and  is  soon  conquered  by  habitual  immersions. 
The  capillaries  of  the  skin  are  rendered  torpid  by  the  subduc- 
tion  of  the  stimulus  of  heat,  and  by  the  consequent  diminutions 
of  the  sensorial  power  of  irritation.  The  capillaries  of  the  lungs 
are  rendered  torpid  by  the  diminution  of  the  sensorial  power  of 
association,  which  is  now  excited  in  less  quantity  by  the  lessen- 
ed actions  of  the  capillaries  of  the  skin,  with  which  they  are 
catenated.  So  that  at  this  time  both  the  cutaneous  and  pulmo- 
nary capillaries  are  principally  actuated,  as  far  as  they  have  any 
action,  by  the  stimulus  of  the  blood.  But  in  a short  time  the 
sensorial  powers  of  irritation,  and  of  association,  become  accu- 
mulated, and  very  energetic  action  of  both  these  membranes 
succeeds.  Which  thus  resemble  the  cold  and  hot  fit  of  an  in- 
termittent fever. 

6.  Dyspepsia  a pedibus  frigidis.  When  the  feet  are  long  cold, 
as  in  riding  in  cold  and  wet  weather,  some  people  are  very 
liable  to  indigestion  and  consequent  heart-burn.  The  irritative 
motions  of  the  stomach  become  torpid,  and  do  their  office  of 

VOL.  II,  3 F 


402 


DISEASES 


Glass  IV.  2.  1.  7. 


digestion  imperfectly,  in  consequence  of  their  association  with  the 
torpid  motions  of  the  vessels  of  the  extremities.  Fear,  as  it  pro- 
duces paleness  and  torpidity  of  the  skin,  frequently  occasions  tem- 
porary indigestion  in  consequence  of  this  association  of  the  vessels 
of  the  skin  with  those  of  the  stomach;  as  riding  in  very  bad  roads 
will  give  flatulency  and  indigestion  to  timorous  people. 

A short  exposure  to  cold  air  increases  digestion,  which  is  then 
owing  to  the  reverse  sympathy  between  the  capillary  vessels  of 
the  skin,  and  of  the  stomach.  Hence  when  the  body  is  exposed 
to  cold  air,  within  certain  limits  of  time  and  quantity,  a reverse 
sympathy  of  the  stomach  and  the  skin  first  occurs,  and  afterwards 
a direct  sympathy.  In  the  former  case  the  expenditure  of  sen- 
sorial power  by  the  skin  being  lessened,  but  not  its  production  in 
the  brain;  the  second  link  of  the  association,  viz.  the  stomach, 
acquires  a greater  share  of  it.  In  the  latter  case,  by  the  con- 
tinuation of  the  deficient  stimulus  of  heat,  the  torpor  becomes  ex- 
tended to  the  brain  itself,  or  to  the  trunks  of  the  nerves;  and 
universal  inactivity  follows. 

7.  Tussis  a peclibus  frigidis.  On  standing  with  the  feet  in 
thawing  snow,  many  people  are  liable  to  incessant  coughing. 
From  the  torpidity  of  the  absorbent  vessels  of  the  lungs,  in  con- 
sequence of  their  irritative  associations  with  those  of  the  skin, 
they  cease  to  absorb  the  saline  part  of  the  secreted  mucus;  and 
a cough  is  thus  induced  by  the  irritation  of  this  saline  secretion; 
which  is  similar  to  that  from  the  nostrils  in  frosty  weather,  but 
differs  in  respect  to  its  immediate  cause;  the  former  being  from 
association  with  a distant  part,  and  the  latter  from  defect  of  the 
stimulus  of  heat  on  the  nostrils  themselves.  See  Catarrhus  fri- 
gidus,  Class  I.  2.  3.  3. 

8.  Tussis  hepatica.  The  cough  of  inebriates,  which  attends 
the  enlargement  of  the  liver,  ora  chronical  inflammation  of  its 
upper  membrane,  is  supposed  to  be  produced  by  the  inconvenience 
the  diaphragm  suffers  from  the  compression  or  heat  of  the  liver. 
It  differs  however  essentially  from  that  attending  hepatitis,  from 
its  not  being  accompanied  with  fever.  And  is  perhaps  rather 
owing  to  irritative  association,  or  reverse  sympathy,  between  the 
lungs  and  the  liver.  As  occurs  in  sheep,  which  are  liable  to  a 
perpetual  dry  cough,  when  the  fluke-worm  is  preying  on  the  sub- 
stance of  their  livers.  See  Class  II.  1.  1.  5. 

M.  M.  From  half  a grain  to  a grain  of  opium  twice  a day.  A 
drachm  of  mercurial  ointment  rubbed  on  the  region  of  the  liver 
every  night  for  eight  or  ten  times. 

9.  Tussis  arthritica.  Gout-cough.  I have  seen  a cough, 
which  twice  recurred  at  a few  years  distance  in  the  same  per- 
son, during  his  fits  of  the  gout,  with  such  pertinacity  and  violence 


Class  IV.  2.  1.  10. 


OF  ASSOCIATION. 


403 


as  to  resist  venesection,  opiates,  bark,  blisters,  mucilages, 
and  all  the  usual  methods  employed  in  coughs.  It  was  for  a 
time  supposed  to  be  the  hooping  cough,  from  the  violence  of  the 
action  of  coughing;  it  continued  two  or  three  weeks,  the  patient 
never  being  able  to  sleep  more  than  a few  minutes  at  once  during 
the  whole  time,  and  being  propped  up  in  bed  with  pillows  night 
and  day. 

As  no  fever  attended  this  violent  cough,  and  but  little  expec- 
toration, and  that  of  a thin  and  frothy  kind,  I suspected  the 
membrane  of  the  lungs  to  be  rather  torpid  than  inflamed,  and 
that  the  saline  part  of  the  mucus  not  being  absorbed,  stimulated 
them  into  perpetual  exertion.  And  lastly,  that  though  the  lungs 
are  not  sensible  to  cold  and  heat,  and  probably  therefore  less  mo- 
bile, yet,  as  they  are  nevertheless  liable  to  consent  with  the  tor- 
por of  cold  feet,  as  described  in  species  6 of  this  Genus,  I sus- 
pected this  torpor  of  the  lungs  to  succeed  the  gout  in  the  feet,  or 
to  act  a vicarious  part  for  them. 

10.  Vertigo  rotatoria.  In  the  vertigo  from  circumgyration 
the  irritative  motions  of  vision  are  increased;  which  is  evinced 
from  the  pleasure  that  children  receive  on  being  rocked  in  a 
cradle,  or  by  swinging  on  a rope.  For  whenever  sensation  arises 
from  the  production  of  irritative  motion  with  less  energy  than 
natural,  it  is  of  the  disagreeable  kind,  as  from  cold  or  hunger; 
but  when  it  arises  from  their  production  with  greater  energy 
than  natural,  if  it  be  confined  within  certain  limits,  it  is  of  the 
pleasurable  kind,  as  by  warmth  or  wine.  With  these  increased 
irritative  motions  of  vision,  I suppose  those  of  the  stomach  are 
performed  with  greater  energy  by  direct  sympathy;  but  when 
the  rotatory  motions,  which  produce  this  agreeable  vertigo,  are 
continued  too  long,  or  are  too  violent,  sickness  of  the  stomach 
follows;  which  is  owing  to  the  decreased  action  of  that  organ 
from  its  reverse  sympathy  with  the  increased  actions  of  the  or- 
gan of  vision.  For  the  expenditure  of  sensorial  power  by  the 
organ  of  vision  is  always  very  great,  as  appears  by  the  size  of 
the  optic  nerves;  and  is  now  so  much  increased  as  to  deprive  the 
next  link  of  association  of  its  due  share.  As  mentioned  in  Spe- 
cies 6 of  this  Genus. 

In  the  same  manner  the  undulations  of  water,  or  the  motions 
of  a ship,  at  first  give  pleasure  by  increasing  the  irritative  mo- 
tions belonging  to  the  sense  of  vision;  but  produce  sickness  at 
length  by  expending  on  one  part  of  the  associated  train  of  irrita- 
tive actions  too  much  of  that  sensorial  power,  which  usually  served 
the  whole  of  it;  whence  some  other  parts  of  the  train  acquire  too 
little  of  it,  and  perform  their  actions  in  consequence  too  feebly, 
and  thence  become  attended  with  disagreeable  sensation. 


404 


DISEASES 


Class  IV.  2.  1.  10- 


It  must  also  be  observed,  that  when  the  irritative  motions  arc 
stimulated  into  unusual  action,  as  in  inebriation,  they  become 
succeeded  by  sensation,  either  of  the  pleasurable  or  painful  kind; 
and  thus  a new  link  is  introduced  between  the  irritative  motions 
thus  excited,  and  those  which  used  to  succeed  them;  whence 
the  association  is  either  dissevered  or  much  weakened,  and  thus 
the  vomiting  in  sea-sickness  occurs  from  the  defect  of  the  power 
of  association,  rather  than  from  the  general  deficiency  of  senso- 
rial power. 

When  a blind  man  turns  round,  or  when  one,  who  is  not 
blind,  revolves  in  the  dark,  a vertigo  is  produced  belonging  to 
the  sense  of  touch.  A blind  man  balances  himself  by  the  sense 
of  touch,  which  being  a less  perfect  means  of  determining  small 
quantities  of  deviation  from  the  perpendicular,  occasions  him  to 
walk  more  carefully  upright  than  those  who  balance  themselves 
by  vision.  When  he  revolves,  the  irritative  associations  of  the 
muscular  motions,  which  were  used  to  preserve  his  perpendicu- 
larity, become  disordered  by  their  new  modes  of  successive  ex- 
ertion; and  he  begins  to  fall.  For  his  feet  now  touch  the  floor 
in  manners  or  directions  different  from  those  they  have  been  ac- 
customed to;  and  in  consequence  he  judges  less  perfectly  of  the 
situation  of  the  parts  of  the  floor  in  respect  to  that  of  his  own 
body,  and  thus  loses  his  perpendicular  attitude.  This  may  be 
illustrated  by  the  curious  experiment  of  crossing  one  finger  over 
the  next  to  it,  and  feeling  a nut  or  bullet  with  the  ends  of  them. 
When,  if  the  eyes  be  closed,  the  nut  or  bullet  appears  to  be  two, 
from  the  deception  of  the  sense  of  touch. 

In  this  vertigo  from  gyration,  both  of  the  sense  of  sight,  and 
of  the  sense  of  touch,  the  primary  link  of  the  associated  irritative 
motions  is  increased  in  energy,  and  the  secondary  ones  are  in- 
creased at  first  by  direct  sympathy;  but  after  a time  they  become 
decreased  by  reverse  sympathy  with  the  primary  link,  owing  to 
the  exhaustion  of  sensorial  power  in  general,  or  to  the  power  of 
association  in  particular;  because  in  the  last  case,  either  pleasur- 
able or  painful  sensation  has  been  introduced  between  the  links 
of  a train  of  irritative  motions,  and  has  dissevered,  or  much  en- 
feebled them. 

Dr.  Smyth,  in  his  Essay  on  Swinging  in  Pulmonary  Consump- 
tion, has  observed,  that  swinging  makes  the  pulse  slower.  Dr. 
Ewart  of  Bath  confirmed  this  observation  both  on  himself  and 
on  Col.  Cathcart,  who  was  then  hectic,  and  that  even  on  ship- 
board, where  some  degree  of  vertigo  might  be  supposed  previ- 
ously to  exist.  Dr.  Currie  of  Liverpool  not  only  confirmed  this 
observation  frequently  on  himself,  when  he  was  also  phthisical, 
but  found  that  equitation  had  a similar  effect  on  him,  uniformly 


Class  IV.  2. 1. 10. 


OF  ASSOCIATION. 


405 


retarding  his  pulse.  This  curious  circumstance  cannot  arise 
from  the  general  effect  of  exercise,  or  fatigue,  as  in  those  cases 
the  pulse  becomes  weaker  and  quicker;  it  must  therefore  be  as- 
cribed to  a degree  of  vertigo,  which  attends  all  those  modes  of 
motion,  which  we  are  not  perpetually  accustomed  to. 

Dr.  Currie  has  further  observed,  that  “ in  cases  of  great  de- 
bility the  voluntary  muscular  exertion  requisite  in  a swing  pro- 
duces weariness,  that  is,  increases  debility;  and  that  in  such  in- 
stances he  had  frequently  noticed,  that  the  diminution  of  the  fre- 
quency of  the  pulse  did  not  take  place,  but  the  contrary.”  These 
circumstances  may  thus  be  accounted  for. 

The  links  of  association,  which  are  affected  in  the  vertigo  oc- 
casioned by  unusual  motion,  are  the  irritative  motions  of  the 
sense  of  vision,  those  of  the  stomach,  and  those  of  the  heart  and 
arteries.  When  the  irritative  ideas  of  vision  are  exerted  with 
greater  energy  at  the  beginning  of  vertigo,  a degree  of  sensation 
is  excited,  which  is  of  the  pleasurable  kind,  as  above  mentioned; 
whence  the  associated  trains  of  irritative  motions  of  the  stomach, 
and  heart,  and  arteries,  act  at  first  with  greater  energy,  both  by 
direct  sympathy,  and  by  the  additional  sensorial  power  of  sensa- 
tion, whence  the  pulse  of  a consumptive  patient  becomes  stronger 
and  consequently  slower. 

But  if  this  vertigo  becomes  much  greater  in  degree  or  dura- 
tion, the  first  link  of  this  train  of  associated  irritative  motions 
expends  too  much  of  the  sensorial  power,  which  was  usually  em- 
ployed on  the  Avhole  train;  and  the  motions  of  the  stomach  be- 
come in  consequence  exerted  with  less  energy.  This  appears, 
because  in  this  degree  of  vertigo  sickness  supervenes,  as  in  sea- 
sickness, which  has  been  shewn  to  be  owing  to  less  energetic  ac- 
tion of  the  stomach.  And  the  motions  of  the  heart  and  arteries 
then  become  weaker,  and  in  consequence  more  frequent,  by  their 
direct  sympathy  with  the  lessened  actions  of  the  stomach.  See 
Supplement,  I.  12.  and  Class  II.  1.  6.  7.  The  general  weak- 
ness from  fatigue  is  owing  to  a similar  cause,  that  is,  to  the  too 
great  expenditure  of  sensorial  power  in  the  increased  actions  of 
one  part  of  the  system,  and  the  consequent  deficiency  of  it  in 
other  parts,  or  in  the  whole. 

The  abatement  of  the  heat  of  the  skin  in  hectic  fever  by 
swinging,  is  not  only  owing  to  the  increased  ventilation  of  cool 
air,  but  to  the  reverse  sympathy  of  the  motions  of  the  cutaneous 
.capillaries  with  those  of  the  heart  and  arteries;  which  occurs  in 
all  fevers  with  arterial  debility,  and  a hot  or  dry  skin.  Hence 
during  moderate  swinging  the  action  of  the  heart  and  arteries 
becomes  stronger  and  slower,  and  the  action  of  the  capillaries, 
which  was  before  too  great,  as  appeared  by  the  heat  of  the  skin, 


406 


DISEASES 


Class  TV.  2. 1.  II. 


is  now  lessened  by  their  reverse  sympathy  with  that  of  the  heart 
and  arteries.  See  Supplement,  I.  8. 

11.  Vertigo  visualis.  Visual  vertigo.  The  vertigo  rotatoria 
described  above,  was  induced  by  the  rotation  or  undulation  of 
external  objects,  and  was  attended  with  increased  action  of  the 
primary  link  of  the  associated  motions  belonging  to  vision,  and 
with  consequent  pleasure.  The  vertigo  visualis  is  owing  to  less 
perfect  vision,  and  is  not  accompanied  with  pleasurable  sensa- 
tion. This  frequently  occurs  in  strokes  of  the  palsy,  and  is  then 
succeeded  by  vomiting;  it  sometimes  precedes  epileptic  fits, 
and  often  attends  those,  whose  sight  begins  to  be  impaired  by 
age. 

In  this  vertigo  the  irritative  ideas  of  the  apparent  motions  of 
objects  are  less  distinct,  and  on  that  account  are  not  succeeded 
by  their  usual  irritative  associations  of  motion;  but  excite  our 
attention.  Whence  the  objects  appear  to  librate  or  circulate 
according  to  the  motions  of  our  heads,  which  is  called  dizziness; 
and  we  lose  the  means  of  balancing  ourselves,  or  preserving  our 
perpendicularity,  by  vision.  So  that  in  this  vertigo  the  motions 
of  the  associated  organs  are  decreased  by  direct  sympathy  with 
their  primary  link  of  irritation;  as  in  the  preceding  case  of  sea- 
sickness they  are  decreased  by  reverse  sympathy. 

When  vertigo  affects  people  about  fifty  years  of  age,  their 
sight  has  generally  been  suddenly  impaired;  and  from  their  less 
accurate  vision  they  do  not  soon  enough  perceive  the  apparent 
motions  of  objects;  like  a person  in  a room,  the  walls  of  which 
are  stained  with  the  uniform  figures  of  lozenges,  explained  in 
Sect.  XX.  1.  This  is  generally  ascribed  to  indigestion;  but  it 
ceases  spontaneously  as  the  patient  acquires  the  habit  of  balanc- 
ing himself  by  less  distinct  objects. 

A gentlemen  about  50  was  seized  with  an  uncommon  degree 
of  vertigo,  so  as  to  fall  on  the  ground,  and  not  be  able  to  turn 
his  head,  as  he  sat  up  either  in  his  chair  or  in  his  bed,  and  this 
continued  eight  or  ten  weeks.  As  he  had  many  decayed  teeth 
in  his  mouth,  and  the  vertigo  was  preceded  and  sometimes  ac- 
companied by  pains  on  one  side  of  his  head,  the  disease  of  a 
tooth  was  suspected  to  be  the  cause.  And  as  his  timidity7  was 
too  great  to  admit  the  extraction  of  those  which  were  de- 
cayed; after  the  trial  of  cupping  repeatedly,  fomentations  on 
his  head,  repeated  blisters,  with  valerian,  Peruvian  bark,  musk, 
opium,  and  variety  of  other  medicines;  mercurials  were  used, 
both  externally  and  internally,  with  design  to  inflame  the  mem- 
branes of  the  teeth,  and  by  that  means  to  prevent  the  torpor  of 
the  action  of  the  membranes  about  the  temple,  and  parietal  bone: 
which  are  catenated  with  the  membranes  of  the  teeth  by  irrita- 


Class  IV.  2.  1. 12. 


OF  ASSOCIATION. 


401 


tive  association,  but  not  by  sensitive  association.  The  event  was, 
that  as  soon  as  the  gums  became  sore  with  a slight  ptyalism,  the 
pains  about  the  head  and  vertigo  gradually  diminished,  and,  dur- 
ing the  soreness  of  his  gums,  entirely  ceased;  but  I believe  re- 
curred afterwards,  though  in  less  degree. 

The  idea  of  inflaming  the  membranes  of  the  teeth  to  produce 
increased  sensation  in  them,  and  thus  to  prevent  their  irritative 
connexion  with  those  of  the  cranium,  was  taken  from  the  treat- 
ment of  trismus,  or  locked  jaw,  by  endeavouring  to  inflame  the 
injured  tendon;  which  is  said  to  prevent  or  remove  the  spasm  of 
the  muscles  of  the  jaw.  See  Class  III.  1.  1.  13.  and  15. 

M.  M.  Emetics.  Blisters.  Issues  about  the  head.  Extrac- 
tion of  decayed  teeth.  Slight  salivation.  Sorbentia.  Incitantia. 
Galvanism. 

A lady  was  suddenly  seized  with  violent  vertigo,  so  as  to  pre- 
vent her  walking  safely  across  the  room;  this  was  attended  with 
considerable  diminution  of  sight;  and  after  various  evacuations 
and  other  medicines  had  been  tried  without  cure,  Mr.  Volta’s  gal- 
vanic pillar  was  used,  consisting  of  about  thirty  plates  of  silver, 
the  diameter  of  about  one  inch  and  a half,  and  as  many  zinc 
plates,  with  interposed  circles  of  cloth  moistened  with  brine. 
A wire  connected  with  each  end  of  this  pillar  was  approached 
repeatedly  to  her  temples,  which  were  previously  moistened  with 
brine,  and  100  galvanic  shocks  were  daily  passed  through  the 
optic  nerves,  which  soon  appeared  to  be  of  great  advantage,  and 
she  soon  recovered,  both  from  the  vertigo  and  dimness  of  sight. 

12.  Vertigo  ebrios a.  Vertigo  from  intoxication  is  owing  to  the 
association  of  the  irritative  ideas  of  vision  with  the  irritative  mo- 
tions of  the  stomach.  Whence  when  these  latter  become  much 
increased  by  the  immoderate  stimulus  of  wine,  the  irritative  mo- 
tions of  the  retina  are  produced  with  less  energy  by  reverse  sym- 
pathy, and  become  at  the  same  time  succeeded  by  sensation  in 
consequence  of  their  decreased  action.  See  Sect.  XXI.  3.  and 
XXXV.  1.  2.  So  conversely  when  the  irritative  motions  of  vision 
are  increased  by  turning  round,  or  by  our  unaccustomed  agitation 
at  sea,  those  of  the  stomach  become  inverted  by  reverse  sympathy, 
and  are  attended  in  consequence  with  disagreeable  sensation. 
Which  decreased  action  of  the  stomach  is  in  consequence  of  the 
increased  expenditure  of  the  sensorial  power  on  the  irritative 
ideas  of  vision,  as  explained  in  Vertigo  rotatoria. 

Whence,  though  a certain  quantity  of  vinous  spirit  stimulate'* 
the  whole  system  into  increased  action,  and  perhaps  even  in- 
creases the  secretion  of  sensorial  power  in  the  brain;  yet  as  soon 
as  any  degree  of  vertigo  is  produced,  it  is  a proof,  that  by  the  too 


408 


DISEASES 


Class  IV.  2.  1.  13, 

great  expenditure  of  sensorial  power  by  the  stomach,  and  its 
nearest  associated  motions,  the  more  distant  ones,  as  those  of  vi- 
sion, become  imperfectly  exerted.  From  hence  may  be  deduced 
the  necessity  of  exhibiting  wine  in  fevers  with  weak  pulse,  in  only 
appropriated  quantity;  because  if  the  least  intoxication  be  in- 
duced, some  part  of  the  system  must  act  more  feebly  from  the 
unnecessary  expenditure  of  sensorial  power. 

13.  Vertigo  febriculosa.  Vertigo  in  fevers  either  proceeds 
from  the  general  deficiency  of  sensorial  power  belonging  to  the 
irritative  associations,  or  to  a greater  expenditure  of  it  on  some 
links  of  the  trains  and  tribes  of  associated  irritative  motions. 
There  is,  however,  a slighter  vertigo  attending  all  people,  who 
have  been  long  confined  in  bed,  on  their  first  rising;  owing  to 
their  having  been  so  long  unused  to  the  apparent  motions  of  ob- 
jects in  their  erect  posture,  or  as  they  pass  by  them,  that  they 
have  lost  in  part  the  habit  of  balancing  themselves  by  them. 

14.  Vertigo  cerebrosa.  Vertigo  from  injuries  of  the  brain, 
either  from  external  violence,  or  which  attend  paralytic  attacks, 
are  owing  to  the  general  deficiency  of  sensorial  power.  In  these 
distressful  situations,  the  vital  motions,  or  those  immediately  ne- 
cessary to  life,  claim  their  share  of  sensorial  power  in  the  first 
place,  otherwise  the  patient  must  die;  and  those  motions,  which 
are  less  necessary,  feel  a deficiency  of  it,  as  these  of  the  organs  of 
sense  and  muscles;  which  constitute  vertigo;  and  lastly,  the  vo- 
luntary motions,  which  are  still  less  immediately  necessary  to 
life,  are  frequently  partially  destroyed,  as  in  palsy;  or  totally,  as 
in  apoplexy. 

15.  Murmur  aurium  vertiginosum.  The  vertiginous  murmur 
in  the  ears,  or  noise  in  the  head,  is  compared  to  the  undulations 
of  the  sound  of  bells,  or  to  the  humming  of  bees.  It  frequently 
attends  people  about  sixty  years  of  age;  and  like  the  visual  ver- 
tigo described  above,  is  owing  to  our  hearing  less  perfectly  from 
the  gradual  inirritability  of  the  organ  on  the  approach  of  age; 
and  the  disagreeable  sensation  of  noise  attending  it,  is  owing  to 
the  less  energetic  action  of  these  irritative  motions;  which  not 
being  sufficiently  distinct  to  excite  their  usual  associations,  be- 
come succeeded  by  our  attention,  like  the  indistinct  view  of  the 
apparent  motions  of  objects  mentioned  in  Vertigo  visualis.  This 
may  be  better  understood,  from  considering  the  use  which 
blind  men  make  of  these  irritative  sounds,  which  they  have 
taught  themselves  to  attend  to,  but  which  escape  the  notice  of 
others.  The  late  blind  Justice  Fielding  walked  for  the  first 
time  into  my  room,  when  he  once  visited  me,  and  after  speak- 
ing a few  words,  said,  “This  room  is  about  22  feet  long,  18 


C.lass  IV.  2.  1.  16. 


OF  ASSOCIATION. 


409 


wide,  and  12  high;”  all  whifch  he  guessed  by  the  ear  with  great 
accuracy.  Now  if  these  irritative  sounds,  from  the  partial  loss 
of  hearing,  do  not  correspond  with  the  size  of  usual  echoes  of 
the  places  where  we  are;  their  catenation  with  other  irritative 
ideas,  as  those  of  vision,  becomes  dissevered  or  disturbed;  and  we 
attend  to  them  in  consequence,  which  I think  unravels  this  in- 
tricate circumstance  of  noises  being* always  heard  in  the  head, 
when  the  sense  of  hearing  begins  to  be  impaired,  from  whatever 
cause  it  occurs. 

This  ringing  in  the  ears  also  attends  the  vertigo  from  intoxi- 
cation; for  the  irritative  ideas  of  sound  are  then  more  weakly 
excited  in  consequence  of  the  deficiency  of  the  sensorial  power 
of  association.  As  is  known  by  this  also  being  attended  with 
disagreeable  sensation,  and  by  its  accompanying  other  diseases  of 
debility,  as  strokes  on  the  head,  fainting  fits,  and  paralytic  seiz- 
ures. For  in  this  vertigo  from  intoxication  so  much  sensorial 
power  in  general  is  expended  on  the  increased  actions  of  the  sto- 
mach, and  its  nearest  connections,  as  the  capillaries  of  the  skin; 
that  there  is  a deficiency  for  the  purposes  of  the  other  irritative 
associations  of  motions  usually  connected  with  it.  This  auditory 
vertigo  attends  both  the  rotatory  and  the  visual  vertigo  above- 
mentioned;  in  the  former  it  is  introduced  by  reverse  sympathy, 
that  is,  by  the  diminution  of  sensorial  power;  too  great  a quan- 
tity of  it  being  expended  on  the  increased  irritative  motions  of 
vision;  in  the  latter  it  is  produced  either  by  the  same  causes  which 
produced  the  visual  vertigo,  or  by  direct  sympathy  with  it.  See 
Sect.  XX.  7. 

M.  M.  Stimulate  the  internal  ear  by  ether,  or  with  essential 
oil  diluted  with  expressed  oil,  or  with  a solution  of  opium  in 
wine,  or  in  water.  Or  with  salt  and  water.  Apply  a cupping 
glass  over  the  ear.  See  I.  2.  5.  6.  Galvanic  shocks  through 
the  temples.  See  IV.  2.  1.  11. 

16.  T actus,  gustus , olf actus,  vertiginosi.  Vertiginous  touch, 
taste,  and  smell.  In  the  vertigo  of  intoxication,  when  the  patient 
lies  down  in  bed,  it  sometimes  happens  even  in  the  dark,  that 
the  bed  seems  to  librate  under  him,  and  he  is  afraid  of  falling 
out  of  it.  The  same  occurs  to  people,  who  are  sea-sick,  even 
when  they  lie  down  in  the  dark.  In  these  the  irritative  motions 
of  the  nerves  of  touch,  or  irritative  tangible  ideas,  are  performed 
with  less  energy,  in  one  case  by  reverse  sympathy  with  the  sto- 
mach, in  the  other  by  reverse  sympathy  with  the  nerves  of  vision, 
and  in  consequence  become  attended  with  sensation,  and  pro- 
duce the  fear  of  falling  by  other  associations. 

A vertigo  of  the  sense  of  touch  may  be  produced,  if  any  one 
turns  round  for  a time  with  his  eyes  shut,  and  suddenly  stops 

VOL.  II.  3 G 


DISEASES 


Class  IV.  2.  1.  17. 


410 

without  opening  them;  for  he  will  for 'a  time  seem  to  be  still 
going  forwards;  which  is  difficult  to  explain.  See  Sect.  XX.  6. 

In  the  beginning  of  some  fevers,  along  with  incessant  vomit- 
ing, the  patients  complain  of  disagreeable  tastes  in  their  mouths, 
and  disagreeable  odours;  which  are  to  be  ascribed  to  the  gene- 
ral debility  of  the  great  trains,  and  tribes  of  associated  irrita- 
tive motions,  and  to  be  explained  from  their  direct  sympathy 
with  the  decreased  action  of  a sick  stomach,  or  from  the  less  se- 
cretion of  sensorial  power  in  the  brain.  These  organs  of  sense 
are  constantly  stimulated  into  action  by  the  saliva  or  by  the  air; 
hence,  like  the  sense  of  hunger,  when  they  are  torpid  from  want 
of  stimulus,  or  from  want  of  sensorial  power,  pain,  or  disagreea- 
ble sensation  ensues,  as  of  hunger,  or  faintness,  or  sickness  in  one 
case;  and  the  ideas  of  bad  tastes  or  odours  in  the  other.  This 
accords  with  the  laws  of  causation,  Sect.  IV.  5. 

17.  Pulsus  mollis  in  vomitione.  The  softness  of  the  pulse  in 
the  act  of  vomiting  is  caused  by  direct  association  between  the 
heart  and  the  stomach;  as  explained  in  Sect.  XXV.  17.  A great 
slowness  of  the  pulsation  of  the  heart  sometimes  attends  sick- 
ness, and  even  with  intermissions  of  it,  as  in  the  exhibition  of  too 
great  a dose  of  digitalis. 

18.  Pulsus  intermittens  a ventriculo.  When  the  pulse  first  be- 
gins to  intermit,  it  is  common  for  the  patient  to  bring  up  a little 
air  from  his  stomach;  which  if  he  accomplishes  before  the  inter- 
mission occurs,  always  prevents  it;  whence  that  this  debility 
of  the  heart  is  owing  to  the  direct  association  of  its  motions  with 
those  of  the  stomach  is  well  evinced.  See  Sect.  XXV.  17. 

I this  morning  saw  Mr. , who  has  long  had  at  times 

an  unequal  pulse,  with  indigestion  and  flatulency,  and  occasional 
asthma;  he  was  seized  two  days  ago  with  diarrhoea,  and  this 
morning  with  sickness,  and  his  pulse  was  every  way  unequal. 
After  an  emetic  his  pulse  still  continued  very  intermittent 
and  unequal.  He  then  took  some  breakfast  of  toast  and  butter, 
and  tea,  and  to  my  great  surprise  his  pulse  became  immediately 
perfectly  regular,  about  100  in  a minute,  and  not  weak,  by  this 
stimulus  on  his  stomach. 

A person,  who  for  many  years  had  had  a frequent  intermis- 
sion of  his  pulse,  and  occasional  palpitation  of  his  heart,  was  re- 
lieved from  them  both  for  a time,  by  taking  about  four  drops  of 
a saturated  solution  of  arsenic  three  or  four  times  a day  for  three 
or  four  days.  As  this  intermission  of  the  pulse  is  occasioned  by 
the  direct  association  of  the  motions  of  the  heart  with  those  of 
the  stomach,  the  indication  of  cure  must  be  to  strengthen  the  ac- 
tion of  the  stomach  by  the  bark.  Spice.  Moderate  quantities 


Class  IV.  2. 1. 19. 


OP  ASSOCIATION. 


411 


of  wine.  A blister.  Half  a grain  of  opium  twice  a day.  So- 
lution of  arsenic? 

1 9.  Febris  inirritativa . Inirritative  fever  described  in  Class 
I.  2.1.  1.  belongs  to  this  place,  as  it  consists  of  disordered  trains 
and  tribes  of  associated  irritative  motions,  with  lessened  actions 
of  the  associated  organs.  In  this  fever  the  pulsations  of  the 
heart  and  arteries  are  weakened  or  lessened,  not  only  in  the 
cold  paroxysm,  as  in  the  irritative  fever,  but  also  in  the  hot  pa- 
roxysm. The  capillary  arteries  or  glands  have  their  actions 
nevertheless  increased  after  the  first  cold  fit,  as  appears  by  the 
greater  production  of  heat,  and  the  glow  of  arterial  blood  in  the 
cutaneous  vessels;  and  lastly  the  action  of  the  stomach  is  much 
impaired  or  destroyed,  as  appears  by  the  total  want  of  appetite  to 
solid  food.  Whence  it  would  seem  that  the  torpid  motions  of 
the  stomach,  whatever  may  occasion  them,  are  a very  frequent 
cause  of  continued  fever  with  weak  pulse;  and  that  these  torpid 
motions  of  the  stomach  do  not  sufficiently  excite  the  sensorial 
power  of  association,  which  contributes  in  health  to  actuate  the 
.heart  and  arteries  along  with  the  irritation  produced  by  the  sti- 
mulus of  the  blood;  and  hence  the  actions  of  these  organs  are 
weaker.  And  lastly,  that  the  accumulation  the  sensorial  power 
of  association,  which  ought  to  be  expended  on  the  motions  of  the 
heart  and  arteries,  becomes  now  exerted  on  the  cutaneous  and 
pulmonary  capillaries.  See  Supplement  I.  8.  and  Sect. 
XXXV.  1.1.  and  XXXIII.  2.  10. 

I have  dwelt  longer  on  the  vertiginous  diseases  in  this  genus, 
both  because  of  their  great  intricacy,  and  because  they  seem  to 
open  a road  to  the  knowledge  of  fever,  which  consists  of  associ- 
ated trains  and  tribes  of  irritative  or  sensitive  motions,  which  are 
sometimes  mixed  with  the  vertiginous  ones;  and  sometimes  sepa- 
rate from  them. 


412 


DISEASES 


ciass  rv.  i.  2. 


ORDO  II. 

Decreased  Associate  Motions. 

GENUS  II. 

Catenated  with  Sensitive  Motions. 

In  this  genus  the  sensorial  power  of  association  is  exerted  with 
less  energy,  and  thence  the  actions  produced  by  it  are  less  than 
natural;  and  pain  is  produced  inconsequence,  according  to  the 
fifth  law  of  animal  causation,  Sect.  IV.  This  pain  is  generally 
attended  with  coldness  of  the  affected  part,  and  is  seldom  suc- 
ceeded by  inflammation  of  it  This  decreased  action  of  the  se- 
condary link  of  the  associated  motions,  belonging  to  this  genus,  is 
owing  to  the  previous  exhaustion  of  sensoriai  power  either  in  the 
increased  actions  of  the  primary  link  of  ihe  associated  motions, 
or  by  the  pain  W'hich  attends  them;  both  which  are  frequently 
the  consequence  of  the  stimulus  of  something  external  to  the  af- 
fected fibres. 

As  pain  is  produced  either  by  excess  or  defect  of  the  natural 
exertions  of  the  fibres,  it  is  not,  considered  separately,  a criteri- 
on of  the  presence  of  either.  In  the  associations  belonging  to 
this  genus  the  sensation  of  pain  or  pleasure  produces  or  attends 
the  primary  link  of  the  associated  motions,  and  very  often  gives 
name  to  the  disease. 

When  great  pain  exists  without  causing  any  fibrous  motions, 
I conjecture  that  it  contributes  to  exhaust  or  expend  the  general 
quantity  of  sensorial  power;  because  people  are  fatigued  by  en- 
during pain,  till  at  length  they  sleep.  Wrhich  is  contrary  to 
what  I had  perhaps  erroneously  supposed  in  Sect.  XXXV.  2.  3. 
If  it  causes  fibrous  motions,  it  then  takes  the  name  of  sensation, 
according  to  the  definition  of  sensation  in  Sect.  II.  2.  9;  and  in- 
creased fibrous  action  or  inflammation  is  the  consequence.  This 
circumstance  of  the  general  exhaustion  of  sensorial  power  by  the 
existence  of  pain  will  assist  in  explaining  many  of  the  diseases  of 
this  genus. 

Many  of  the  canals  of  the  body,  as  the  urethra,  the  bile-duct, 
the  throat,  have  the  motions  of  their  two  extremities  associated  by 
having  been  accustomed  to  feel  pleasurable  or  painful  sensations 
at  the  same  time  or  in  succession.  This  is  termed  sensitive  as- 
sociation, though  those  painful  or  pleasurable  sensations  do  not 
cause  the  motions  but  only  attend  them;  and  are  thus  perhaps, 
strictly  speaking,  only  catenated  with  them. 


Class  IV.  2.  2.  1. 


OF  ASSOCIATION. 


413 


SPECIES. 

1 . Torpor  genaz  a dolore  dentis.  In  tooth-ache  there  is  general- 
ly’a coldness  of  the  cheek,  which  is  sensible  to  the  hand,  and  is 
attended  in  some  degree  with  the  pain  of  cold.  The  cheek  and 
tooth  have  frequently  been  engaged  in  pleasurable  action  at  the 
same  time  during  the  masticating  of  our  food;  whence  they 
have  acquired  sensitive  associations.  The  torpor  of  the  cheek 
may  have  for  its  cause  the  too  great  expenditure  of  sensorial 
power  by  the  painful  sensation  of  the  membranes  of  the  diseas- 
ed tooth;  whence  the  membranes  of  the  cheek  associated  wify 
those  of  the  alveolar  process  are  deprived  of  their  natural  share 
of  it,  and  become  torpid;  thus  they  produce  less  secretions,  and 
less  heat,  and  the  pain  of  cold  is  the  consequence.  This  torpor 
of  the  vessels  of  the  cheek  cannot  be  produced  by  the  activity 
of  the  sensorial  power  of  sensation;  for  then  they  would  act 
more  violently  than  natural,  or  become  inflamed.  And  though 
the  pain  by  exhausting  so  much  sensorial  power  may  be  a re- 
mote cause,  it  is  the  defect  of  the  power  of  association,  which 
is  the  immediate  cause  of  the  torpor  of  the  cheek. 

After  some  hours  this  pain  occasioned  by  the  torpor  of  the 
vessels  of  the  cheek  either  gradually  ceases  along  with  the  pain 
of  the  diseased  tooth;  or,  by  the  accumulation  of  sensorial  powr- 
er  during  their  state  of  torpor,  the  capillaries  of  the  cheek  act 
with  greater  violence,  and  produce  more  secretions,  and  heat, 
and  consequent  tumour,  and  inflammation.  In  this  state  the 
pain  of  the  diseased  tooth  ceases;  as  the  sensorial  power  of  sen- 
sation is  now  expended  on  the  inflamed  vessels  of  the  cheek.  It 
is  probable  that  most  other  internal  membranous  inflammations 
begin  in  a similar  manner;  whence  there  may  seem  to  be  a double 
kind  of  sensitive  association;  first,  with  decreased  action  of  the 
associated  organ,  and  then  with  increased  action  of  it;  but  the 
latter  is  in  this  case  simply  the  consequence  of  the  former;  that 
is,  the  tumor  or  inflammation  of  the  cheek  is  in  consequence 
of  its  previous  quiescence  or  torpor. 

2.  Stranguria  a doloi jp  vesicce.  The  strangury,  which  has  its 
origin  from  pain  at  the  neck  of  the  bladder,  consists  of  a pain  in 
the  external  extremity  of  the  urethra  or  of  the  glans  penis  of 
men,  and  probably  in  the  external  termination  of  the  urethra  or 
of  the  clitoris  of  women;  and  is  owring  to  the  sympathy  of 
these  with  some  distant  parts,  generally  with  the  other  end  of 
the  urethra;  an  endeavour  and  difficulty  of  making  water  at- 
tends this  pain. 

Its  remote  cause  is  from  the  internal  or  external  use  of  can- 
tharides,  which  stimulate  the  neck  of  the  bladder;  or  from  a 


414 


DISEASES 


Class  TV.  2.  2. 3, 


stone,  which,  whenever  it  is  pushed  into  the  neck  of  the  bladder, 
gives  this  pain  of  strangury,  but  not  at  other  times;  and  hence 
it  is  felt  most  severely  in  this  case  after  having  made  water. 

The  sensations  or  sensitive  motions  of  the  glans  penis,  and 
of  the  sphincter  of  the  bladder,  have  been  accustomed  to  exist 
together  during  the  discharge  of  the  urine;  and  hence  the  two 
ends  of  the  urethra  sympathize  by  association,  When  there 
is  a stone  at  the  neck  of  the  bladder,  which  is  not  so  large  or 
rough  as  to  inflame  the  part,  the  sphincter  of  the  bladder  be- 
comes stimulated  into  pain;  but  as  the  glans  penis  is  for  the 
purposes  of  copulation  more  sensitive  than  the  sphincter  of  the 
bladder,  as  soon  as  it  becomes  affected  with  pain  by  the  associa- 
tion above  mentioned,  the  sensation  at  the  neck  of  the  bladder- 
ceases;  and  then  the  pain  of  the  glans  penis  would  seem  to  be 
associated  with  the  irritative  motions  only  of  the  sphincter  of  the 
bladder,  and  not  with  the  sensitive  ones  of  it.  But  a circum- 
stance similar  to  this  occurs  in  epileptic  fits,  which  at  first  are 
induced  by  disagreeable  sensation,  and  afterwards  seem  to  occur 
without  previous  pain,  from  the  suddenness  with  which  they 
follow  and  relieve  the  pain,  which  occasioned  them.  From  this 
analogy  I imagine  the  pain  of  the  glans  penis  is  associated  with 
the  pain  of  the  sphincter  of  the  bladder;  but  that  as  soon  as  the 
greater  pain  in  a more  sensible  part  is  produced;  the  less  pain,  which 
occasioned  it , ceases;  and  that  this  is  one  of  the  laws  of  sensitive 
association.  See  Sect.  XXXV.  2.  1. 

A young  man  had  by  an  accident  swallowed  a large  spoonful 
or  more  of  tincture  of  cantharides;  as  soon  as  he  began  to  feel 
the  pain  of  strangury,  he  was  advised  to  drink  large  quantities 
of  warmish  water:  to  which,  as  soon  as  it  could  be  gotten,  some 
gum  arabic.  was  added.  In  an  hour  or  two  he  drank,  by  inter- 
vals of  a few  minutes,  about  two  gallons  of  water,  and  discharg- 
ed his  urine  every  four  or  five  minutes.  A little  blood  was 
voided  towards  the  end,  but  he  suffered  no  ill  consequence. 

M.  M.  Warm  water  internally.  Clysters  of  warm  water. 
Fomentation.  Opium.  Solution  of  fixed  alkali  supersaturated 
with  carbonic  acid.  A bougie  may  be  u^ed  to  push  back  a stone 
into  the  bladder.  See  Class  I.  1.  3.  10. 

3.  Stranguria  comndsiva.  The  convulsive  strangury,  like  that 
before  described,  is  probably  occasioned  by  the  torpor  or  defec- 
tive action  of  the  painful  part  in  consequence  of  the  too  great 
expenditure  of  sensorial  power  on  the  primary  link  of  the  associ- 
ated motions,  as  no  heat  or  inflammation  attends  this  violent  pain. 
This  kind  of  strangury  recurs  by  stated  periods,  and  sometimes 
arises  to  so  great  a degree,  that  convulsion  or  temporary  mad- 
ness terminates  each  period  of  it.  It  affects  women  oftener 


this*  IV.  2.  2-  4. 


OF  ASSOCIATION. 


415 


than  men,  is  attended  with  cold  extremities  without  fever,  and 
is  distinguished  from  the  stone  of  the  bladder  by  the  regularity 
of  its  periods,  and  by  the  pain  being  not  increased  after  making 
water. 

On  introducing  the  catheter  sometimes  part  of  the  urine  will 
come  away  and  not  the  whole,  which  is  difficult  to  explain; 
but  may  arise  from  the  weakness  of  the  muscular  fibres  of  the 
bladder;  which  are  not  liable  suddenly  to  contract  themselves 
so  far  as  to  exclude  the  whole  of  the  urine.  In  some  old  peo- 
ple, who  have  experienced  a long  retention  of  urine,  the  blad- 
der never  regains  the  power  of  completely  emptying  itself;  and 
many  who  are  beginning  to  be  weak  from  age  can  make  water 
a second  time,  a few  minutes  after  they  supposed  they  had  emp- 
tied the  bladder. 

I have  believed  this  pain  to  originate  frcm  sympathy  with 
some  distant  part,  as  from  ascarides  in  the  rectum,  or  from  piles 
in  women;  or  from  caruncles  in  the  urethra  about  the  caput 
gallinaginis  in  men;  and  that  the  pain  has  been  in  the  glans  or 
clitoris  by  reverse  sympathy  of  these  more  sensible  parts  with 
those  above  mentioned. 

M.  M.  Venesection.  Opium  in  large  quantities.  Warm 
bath.  Balsams.  Bark.  Tincture  of  cantharides.  Bougie,  and 
the  treatment  for  haemorrhoids.  Leeches  applied  to  the  sphinc- 
ter ani.  Aerated  alkaline  water.  Soap  and  sal  soda.  Opium 
in  clysters  given  an  hour  before  the  expected  return.  Smoke  of 
tobacco  in  clysters.  Arsenic. 

4.  Dolor  termini  inteslinalis  duclfis  choledochi.  Pain  at  the  in- 
testinal end  of  the  gall-duct.  When  a gall-stone  is  protruded 
from  the  gall-bladder  a little  way  into  the  end  of  the  gall-duct, 
the  pain  is  felt  at  the  other  end  of  the  gall-duct,  which  termi- 
nates in  the  duodenum.  For  the  actions  of  the  two  terminations 
of  this  canal  are  associated  together  from  the  same  streams 
of  bile  passing  through  them  in  succession,  exactly  as  the  two 
terminations  of  the  urethra  have  their  actions  associated,  as 
described  in  Species  2 and  3 of  this  genus.  But  as  the  in- 
testinal termination  of  the  bile-duct  is  made  more  sensible  for 
the  purpose  of  bringing  down  more  bile,  when  it  is  stimulated 
by  new  supplies  of  food  from  the  stomach,  it  falls  into  violent 
pain  from  association;  and  then  the  pain  on  the  region  of  the 
gall-bladder  ceases,  exactly  as  above  explained  in  the  account 
of  the  pain  of  the  glans  penis  from  a stone  in  the  sphincter  of 
the  bladder. 

The  common  bile-duct  opens  into  the  intestine  exactly  at 
what  is  called  the  pit  of  the  stomach;  and  hence  it  has  some- 
times happened,  that  this  pain  from  association  with  the  sens'a- 


416 


DISEASES 


Class  IV.  2.  2.  5. 


tion  of  a gall-stone  at  the  other  end  of  the  bile-duct  has  been 
mistaken  for  a pain  of  the  stomach. 

For  the  method  of  cure  see  Class  I.  1.  3.  8.  to  which  should  be 
added  the  use  of  strong  electric  shocks  passed  through  the  bile- 
duct  from  the  pit  of  the  stomach  to  the  back,  and  from  one  side 
to  the  other.  A case  of  the  good  effect  of  electricity  in  the 
jaundice  is  related  in  Sect.  XXX.  2.  And  another  case, 
where  it  promoted  the  passage  of  a painful  gall-stone,  is  describ- 
ed by  Dr.  Hall,  experienced  on  himself.  Trans,  of  the  College 
at  Philadelphia,  Vol.  I.  p.  192. 

Haifa  pint  of  warm  water  two  or  three  times  a day  is  much 
recommended  to  dilute  the  inspissated  bile. 

5.  Dolor  pliaryngis  ab  acido  gastrico.  The  two  ends  of  the 
throat  sympathize  by  sensitive  association  in  the  same  manner 
as  the  other  canals  above  mentioned,  namely,  the  urethra  and 
the  bile-duct;  hence  when  too  great  acidity  of  undigested  ali- 
ment, or  the  carbonic  acid  air,  which  escapes  in  fermentation, 
stimulates  the  cardia  ventriculi,  or  lower  end  of  the  gula,  into 
pain,  the  pharynx,  or  upper  end  of  it,  is  affected  with  greater 
pain,  or  a disagreeable  sensation  of  heat. 

6.  Pruritus  narium  a vcrmibus.  The  itching  of  the  nose  from 
worms  in  the  intestines  is  another  curious  instance  of  the  sen- 
sitive associations  of  the  motions  of  membranes;  especially  of 
those  which  constitute  the  canals  of  the  body.  Previous  to  the 
deglutition  of  agreeable  food,  as  milk  in  our  earliest  infancy,  an 
agreeable  odour  affects  the  membrane  which  lines  the  nostrils; 
and  hence  an  association  seems  to  take  place  between  the  agree- 
able sensations  produced  by  food  in  the  stomach  and  bowels,  and 
the  agreeable  sensations  of  the  nostrils.  The  existence  of  asca- 
rides  in  the  rectum  1 believe  produces  this  itching  of  the  nostrils 
more  than  the  worms  in  other  parts  of  the  intestines;  as  we  have 
already  seen,  that  the  terminations  of  canals  sympathize  more 
than  their  other  parts,  as  in  the  urethra  and  gall-ducts.  See 
Glass  I.  1.  5.  9.  IV.  1.  2.  9. 

7.  CephalcBa  sympathetica.  Sympathetic  head-ach.  In  cold  fits 
of  the  ague,  the  head-ach  arises  from  consent  with  some  torpid 
viscus,  like  the  pain  of  the  loins.  After  drunkenness  the  head- 
ach  is  very  common,  owing  to  direct  sympathy  of  the  mem- 
branes of  the  head  with  those  of  the  stomach;  which  is  become 
torpid  after  the  too  violent  stimulus  of  the  preceding  intoxica- 
tion; and  is  hence  removable  by  spirit  of  wine,  or  opium,  ex- 
hibited in  smaller  quantities.  In  some  constitutions  these  head- 
achs  are  induced,  when  the  feet  are  exposed  to  much  external 
cold;  in  this  case  the  feet  should  be  covered  with  oiled  silk, 


OF  ASSOCIATION. 


Class  IV.  2.  2.  8. 


417 


which  prevents  the  evaporation  of  the  perspirable  matter,  and 
thence  diminishes  one  cause  of  external  cold. 

M.  M.  Valerian  in  powder  two  drachms  three  or  four  times  a 
day  is  recommended.  The  bark.  Cbalybeates.  A grain  of 
opium  twice  a day  for  a long  time.  From  five  to  ten  drops  of  the 
saturated  solution  of  arsenic  two  or  three  times  a day.  See  Class 
I.  2.  4.  11.  A lady  once  assured  me,  that  when  her  head-ach 
was  coming  on,  she  drank  three  pints  (pounds)  of  hot  water,  as 
hastily  as  she  could;  which  prevented  the  progress  of  the  disease. 
A solution  of  arsenic  is  recommended  by  Dr.  Fowler  of  York. 
Very  strong  errhines  are  said  sometimes  to  cure  head-achs,  taken 
at  the  times  the  pain  recurs,  till  a few  drops  of  blood  issue  from 
the  nostrils.  As  one  grain  of  turpeth  mineral  (vitriolic  calx  of 
mercury)  mixed  with  ten  grains  of  fine  sugar.  Euphorbium,  or 
cayenne  pepper,  mixed  with  sugar,  and  used  with  caution  as  an 
errhine.  See  the  M.  M.  of  the  next  Species. 

8.  Hemicrania  sympathetica.  Sympathetic  pain  on  one  side 
of  the  head.  This  disease  is  attended  with  cold  skin,  and  hence 
whatever  may  be  the  remote  cause,  the  immediate  one  seems  to 
be  want  of  stimulus,  either  of  heat  or  distention,  or  of  some  other 
unknown  stimulus  in  the  painful  part;  or  in  those  with  which  it 
is  associated.  The  membranes  in  tbeir  natural  state  are  only- 
irritable  by  distention;  in  their  diseased  state,  they  are  sensible 
like  muscular  fibres.  Hence  a diseased  tooth  may  render  the 
neighbouring  membranes  sensible,  and  is  frequently  the  cause  of 
this  disease. 

Sometimes  the  stomach  is  torpid  along  with  the  pained  mem- 
brane of  the  head;  and  then  sickness  and  inappetency  attend 
either  as  causes  or  consequences.  The  natural  cure  of  hemicrania 
is  the  accumulation  of  sensorial  power  during  the  rest  or  sickness 

of  the  patient.  Mrs. is  frequently  liable  to  hemicrania  with 

sickness,  which  is  probably  owing  to  a diseased  tooth;  the  pa- 
roxysm occurs  irregularly,  but  always  after  some  previous  fatigue, 
or  other  cause  of  debility.  She  lies  in  bed,  sick,  and  without 
taking  any  solid  food,  and  very  little  of  fluids,  and  those  of  the 
aqueous  kind,  and,  after  about  48  or  50  hours,  rises  free  from 
complaint.  Similar  to  this  is  the  recovery  from  cold  paroxysms 
of  fever,  from  the  torpor  occasioned  by  fear,  and  from  syncope; 
which  are  all  owing  to  the  accumulation  of  sensorial  power  dur- 
ing the  inactivity  of  the  system.  Hence  it  appears,  that,  though 
when  the  sensorial  powrer  of  volition  is  much  exhausted  by  fa- 
tigue, it  can  be  restored  by  eight  or  ten  hours  of  sleep;  yet,  when 
the  sensorial  power  of  irritation  is  exhausted  by  fatigue,  that  it 
requires  two  whole  solar  or  lunar  days  of  rest,  before  it  can  be 
restored. 

VOL.  II.  3 II 


418 


DISEASES 


Class  IV.  2.  2.  8. 


The  late  Dr.  Monro  asserted  in  his  lectures,  that  he  cured  the 
hemicrania,  or  megrim,  by  a strong  vomit,  and  a brisk  purge  im- 
mediately after  it.  This  method  succeeds  best  if  opium  and  the 
bark  are  given  in  due  quantity  after  the  operation  of  the  cathartic; 
and  with  still  more  certainty,  if  bleeding  in  small  quantity  is  pre- 
mised, where  the  pulse  will  admit  of  it.  See  Sect.  XXXV.  2.  1 . 

Mr.  Kellie  asserts,  that  some  kinds  of  head-achs,  especially 
those  which  arise  from  defect  of  stimulation,  may  be  cured  by 
compressing  the  two  subclavian  arteries,  as  they  pass  over  the 
first  rib;  which  he  thinks  would  produce  a pressure  on  the  brain 
similar  to  that  w7hich  may  be  produced  by  the  centrifugal  force, 
if  a person  was  to  lie  across  a mill-stone  as  it  revolves.  See 
Suppl.  I.  15.  7.  Would  such  a circulating  bed  remove  any  kind 
of  head-ach? 

The  pain  generally  affects  one  eye,  and  spreads  a little  way 
on  that  side  of  the  nose,  and  may  sometimes  be  relieved  by  press- 
ing or  cutting  the  nerve,  where  it  passes  into  the  bone  of  the  orbit 
above  the  eye.  When  it  affects  a small  defined  part  on  the  pa- 
rietal bone  on  one  side,  it  is  generally  termed  Clavus  hystericus, 
and  is  always,  I believe,  owing  to  a diseased  dens  molaris.  The 
tendons  of  the  muscles,  which  serve  the  office  of  mastication,  have 
been  extended  into  pain  at  the  same  time  that  the  membranous 
coverings  of  the  roots  of  the  teeth  have  been  compressed  into 
pain,  during  the  biting  or  mastication  of  hard  bodies.  Hence 
when  the  membranes,  which  cover  the  roots  of  the  teeth,  become 
affected  with  pain  by  a beginning  decay,  or  perhaps  by  the  torpor 
or  coldness  of  the  dying  part  of  the  tooth,  the  tendons  and  mem- 
branous fascia  of  the  muscles  about  the  same  side  of  the  head 
become  affected  with  violent  pain  by  their  sensitive  associations: 
and  as  soon  as  this  associated  pain  takes  place,  the  pain  of  the 
tooth  entirely  ceases,  as  explained  in  the  second  species  of  this 
genus. 

A remarkable  circumstance  attends  this  kind  of  hemicrania, 
viz.  that  it  recurs  by  periods  like  those  of  intermittent  fevers,  as 
explained  in  the  Section  on  Catenation  of  Motions;  these  periods 
sometimes  correspond  with  alternate  lunar  or  solar  days,  like 
tertian  agues,  and  that  even  when  a decaying  tooth  is  evidently 
the  cause;  which  has  been  evinced  by  the  cure  of  the  disease  by 
extracting  the  tooth.  At  other  times  they  observe  the  monthly 
lunations,  and  seem  to  be  induced  by  the  debility  which  attends 
menstruation. 

The  dens  sapientiae,  or  last  tooth  of  the  upper  jaw,  frequent- 
ly decays  first,  and  gives  hemicrania  over  the  eye  on  the  same 
side.  The  first  or  second  grinder  in  the  under  jaw  is  liable 


CtAss  IV.  2.  2.  8, 


OF  ASSOCIATION. 


419 


to  give  violent  pain  about  the  middle  of  the  parietal  bone,  or 
side  of  the  head,  on  the  same  side,  which  is  generally  called  the 
Clavus  hystericus,  of  which  an  instructive  case  is  related  in 
Sect.  XXXV.  2.  1. 

Since  the  above  was  first  published  I have  seen  two  cases, 
which  were  very  similar,  and  seem  much  to  confirm  the  above 
theory  of  sympathetic  hemicrania  being  perhaps  always  owing 
to  the  sympathy  of  the  membranes  about  the  cranium  with 
those  about  diseased  teeth.  Lord  M.  and  Mr.  B.  of  Edinburgh, 
both  of  them  about  the  middle  of  life,  were  afflicted  with  vio- 
lent hemicrania  for  about  two  years;  in  the  beginning  of  which 
time  they  both  assured  me,  that  their  teeth  were  perfectly  sound, 
but  on  inspecting  their  mouths,  I found  all  the  molares  were 
now  so  decayed  as  to  have  lost  their  crowns.  After  having  suf- 
fered pain  for  sixteen  or  eighteen  months  almost  incessantly  in 
different  parts  of  their  heads,  they  had  each  of  them  a hemiple- 
gia, from  which  they  gradually  recovered,  as  much  as  paralytic 
affections  generally  do  recover.  All  the  stumps  of  their  teeth, 
which  were  useless,  were  directed  to  be  extracted;  as  the  swal- 
lowing so  much  putrid  matter  from  decaying  bones  seemed  to 
injure  their  digestion.  They  were  desired  not  to  drink  wine  or 
ale  without  its  being  diluted  with  twice  or  thrice  its  quantity  of 
water,  to  prevent  any  access  of  torpor  from  too  great  previous 
stimulus,  and  to  take  six  grains  of  rhubarb  with  three  of  soap 
made  into  pills,  every  night,  with  some  bitter  and  very  slight 
chalybeate  medicines.  If  the  teeth  which  became  torpid  in  suc- 
cession, could  have  been  discovered,  and  extracted,  before  they 
decayed,  and  could  have  been  replaced,  might  not  this  continu- 
ance of  pain,  and  consequent  paralysis,  have  been  prevented?  or 
might  not  a moderate  salivation  have  effected  this  purpose? 

M.  M.  Detect  and  extract  the  diseased  tooth.  Cut  the  af- 
fected nerve,  or  stimulate  the  diseased  membrane  by  acupunc- 
ture. Venesection  to  six  ounces  by  the  lancet  or  by  leeches. 
A strong  emetic  and  a subsequent  cathartic?  and  then  an  opiate 
and  the  bark.  Pass  small  electric  shocks  through  the  pained 
membrane,  and  through  the  teeth  on  the  same  side.  Apply  vi- 
triolic ether  externally,  and  a grain  of  opium  with  camphor  in- 
ternally, to  the  cheek  on  the  affected  side,  where  a diseased  tooth 
may  be  suspected.  Foment  the  head  with  warm  vinegar. 
Drink  two  large  spoonfuls  of  vinegar.  Stimulate  the  gums  of 
the  suspected  teeth  by  oil  of  cloves,  by  opium.  See  Class  I.  1. 
4.  4.  Snuff  volatile  spirit  of  vinegar  up  the  nostrils.  Lastly, 
in  permanent  head-achs,  as  in  permanent  vertigo,  I have  seen 
good  effect  in  two  cases  by  the  use  of  mercurial  ointment  rubbed 
on  the  shaved  head  or  about  the  throat,  till  a mild  salivation  com- 


420 


DISEASES 


Class  IV.  2.  2.  9. 


mences,  which,  by  inflaming  the  membranes  of  the  teeth,  may 
prevent  their  irritative  sympathy  with  those  of  the  cranium 
Thus  by  inflaming  the  tendon,  which  is  the  cause  of  locked  jaw, 
and  probably  by  inflaming  the  wound,  which  is  the  cause  of  hy- 
drophobia, those  diseases  may  be  cured,  by  disuniting  the  irrita- 
tive sympathy  between  those  parts,  which  may  not  possess  any 
sensitive  sympathy.  This  idea  is  wTell  worth  our  attention. 

Otalgia.  Ear-ach  is  another  disease  occasioned  by  the  sym- 
pathy of  the  membranes  of  the  ear  with  those  which  invest  or 
surround  a decaying  tooth,  as  I have  had  frequent  reason  to  be- 
lieve; and  is  frequently  relieved  by  filling  the  ear  with  tincture 
of  opium.  See  Class  I.  2.  4. 

9.  Dolor  humeri  in  hepatidide.  In  the  efforts  of  excluding  the 
faeces  and  urine  the  muscles  of  the  shoulders  are  exerted  to  com- 
press the  air  in  the  lungs,  that  the  diaphragm  may  be  pressed 
down.  Hence  the  distention  of  the  tendons  or  fibres  of  these 
muscles  is  associated  with  the  distention  of  the  tendons  or  fibres 
of  the  diaphragm;  and  when  the  latter  are  pained  by  the  en- 
largement or  heat  of  the  inflamed  liver,  the  former  sympathize 
with  them.  Sometimes  but  one  shoulder  is  affected,  sometimes 
both;  it  is  probable  that  many  other  pains,  which  are  termed 
rheumatic,  have  a similar  origin,  viz.  from  sensitive  associa- 
tions. 

As  no  inflammation  is  produced  in  consequence  of  this  pain 
of  the  shoulder,  it  seems  to  be  owing  to  inaction  of  the  mem- 
branous part  from  defect  of  the  sensorial  power  of  association, 
of  which  the  primary  link  is  the  inflamed  membrane  of  the  liver; 
which  now  expends  so  much  of  the  sensorial  power  in  general 
by  its  increased  action,  that  the  membranes  about  the  shoulder, 
which  are  links  of  association  with  it,  become  deprived  of  their 
usual  share,  and  consequently  fall  into  torpor. 

10.  Torpor  pedum  in  eruptione  variolarum.  At  the  commence- 
ment of  the  eruption  of  the  small  -pox,  when  the  face  and  breast 
of  children  are  very  hot,  their  extremities  are  frequently  cold. 
This  I ascribe  to  sensitive  association  between  the  different  parts 
of  the  skin;  whence  when  a part  acts  too  violently,  the  other 
part  is  liable  to  act  too  weakly;  and  the  skin  of  the  face  being 
affected  first  in  the  eruption  of  the  small-pox,  the  skin  of  the  feet 
becomes  cold  in  consequence  by  reverse  sympathy. 

M.  M.  Cover  the  feet  with  flannel,  and  expose  the  face  and 
bosom  to  cool  air,  which  in  a very  short  time  both  warms  the 
feet  and  cools  the  face;  and  hence  what  is  erroneously  called  a 
rash,  but  which  is  probably  a too  hasty  eruption  of  the  small-pox, 
disappears;  and  afterwards  fewer  and  more  distinct  eruptions  of 
the  small-pox  supervene. 


Class  IV.  2.  2.  11. 


OF  ASSOCIATION. 


421 


11.  Testium  dolor  nephriticus.  The  pain  and  retraction  of  the 
testicle  on  the  same  side,  when  there  is  a stone  in  the  ureter,  is 
to  be  ascribed  to  sensitive  association;  whether  the  connecting 
cause  be  a branch  of  the  same  nerve,  or  from  membranes,  which 
have  been  frequently  affected  at  the  same  time. 

12.  Dolor  digiti  minimi  sympatheticus.  When  any  one  acci- 
dentally strikes  his  elbow  against  any  hard  body,  a tingling  pain 
runs  down  to  the  little  finger  end.  This  is  owing  to  sensitive 
association  of  motions  by  means  of  the  same  branch  of  a nerve, 
as  in  hemicrania  from  a decaying  tooth,  the  pain  is  owing  to  the 
sensitive  association  of  tendons  or  membranes. 

13.  Dolor  brachii  in  hydrope  pectoris.  The  pain  in  the  left  arm 
which  attends  some  dropsies  of  the  chest,  is  explained  in  Sect. 
XXIX.  5.  2.  10.  which  resembles  the  pain  of  the  little  finger  from 
a percussion  of  the  nerve  at  the  elbow  in  the  preceding  article. 
A numbness  of  this  kind  is  produced  over  the  whole  leg,  when 
the  crural  nerve  is  much  compressed  by  sitting  for  a time  with 
one  leg  crossed  over  the  other. 

Mr. , about  sixty,  had  for  two  years  been  affected  with 

difficulty  of  respiration  on  any  exertion,  with  pain  about  the  ster- 
num, and  of  his  left  arm;  which  last  was  more  considerable  than 
is  usual  in  dropsy  of  the  chest;  some  months  ago  the  pain  of  his 
arm,  after  walking  a mile  or  two,  became  excessive,  with  coldness 
and  numbness;  and  on  the  next  day  the  back  of  the  hand,  and  a 
part  of  the  arm  swelled  and  became  inflamed,  which  relieved  the 
pain;  and  was  taken  for  the  gout,  and  continued  several  days. 
He  after  some  months  became  dropsical  both  in  respect  to  his 
chest  and  limbs,  and  was  six  or  seven  times  perfectly  relieved  by 
one  dram  of  saturated  tincture  of  digitalis,  taken  two  or  three 
times  a day  for  a few  days  in  a glass  of  peppermint  water.  He 
afterwards  breathed  oxygen  gas  undiluted,  in  the  quantity  of  six 
or  eight  gallons  a day  for  three  or  four  weeks  without  any  effect, 
and  sunk  at  length  from  general  debility. 

In  this  instructive  case  I imagine  the  pressure  or  stimulus  of  one 
part  of  the  nerve  within  the  chest  caused  the  other  part,  which 
serves  the  arm,  to  become  torpid,  and  consequently  cold  by  sym- 
pathy; and  that  the  inflammation  was  the  consequence  of  the 
previous  torpor  and  coldness  of  the  arm,  in  the  same  manner  as 
the  swelling  and  inflammation  of  the  cheek  in  tooth-ach,  in  the 
first  species  of  this  genus;  and  that  many  rheumatic  inflammations 
are  thus  produced  by  sympathy  with  some  distant  part. 

14.  Diarrhoea  a dentitione.  The  diarrhoea,  which  frequently 
attends  dentition,  is  the  consequence  of  indigestion;  the  aliment 
acquires  chemical  changes,  and  by  its  acidity  acts  as  a cathartic; 
and  changes  the  yellow  bile  into  green,  which  is  evacuated  along 


422 


DISEASES 


Class  IV.  2.  2.  14. 


with  indigested  parts  of  the  coagulum  of  milk.  The  indigestion 
is  owing  to  the  torpor  of  the  stomach  and  intestines  caused  by 
their  association  with  the  membranes  of  the  gums,  which  are  now 
stimulated  into  great  exertion  with  pain;  both  which  contribute 
to  expend  the  general  quantity  of  sensorial  power,  which  belongs 
to  this  membranous  association;  and  thus  the  stomach  and  intes- 
tines act  with  less  than  their  natural  energy.  This  is  generally 
esteemed  a favourable  symptom  in  difficult  dentition,  as  the  pain 
of  the  alveolar  membranes  exhausts  the  sensorial  power  without 
producing  convulsions  for  its  relief.  See  Class  I.  1.4.  5.  And 
the  diarrhoea  ceases,  as  the  tooth  advances. 


Qiass  TV.  2.  3.  1. 


OF  ASSOCIATION. 


423 


ORDO  II. 

Decreased  Associate  Motions. 

GENUS  III. 

Catenated  with  Voluntary  Motions. 

SPECIES. 

1.  Titubatio  linguae.  Impediment  of  speech  is  owing  to  the 
associations  of  the  motions  of  the  organs  of  speech  being  inter- 
rupted or  dissevered  by  ill-employed  sensation  or  sensitive  mo- 
tions, as  by  awe,  bashfulness,  ambition  of  shining,  or  fear  of  not 
succeeding,  and  the  person  uses  voluntary  efforts  in  vain  to  re- 
gain the  broken  associations,  as  explained  in  Sect.  XVII.  I.  10. 
and  XVII.  2.  10. 

The  broken  association  is  generally  between  the  first  conso- 
nant and  the  succeeding  vowel;  as  in  endeavouring  to  pronounce 
the  word  parable,  the  p is  voluntarily  repeated  again  and  again, 
but  the  remainder  of  the  word  does  not  follow,  because  the  asso- 
ciation between  it  and  the  next  vowel  is  dissevered. 

M.  M.  The  art  of  curing  this  defect  is  to  cause  the  stammerer 
to  repeat  the  word,  which  he  finds  difficult  to  speak,  eight  or  ten 
times  without  the  initial  letter,  in  a strong  voice,  or  with  an  as- 
pirate before  it,  as  arable,  or  harable;  and  at  length  to  speak  it 
very  softly  with  the  initial  letter  p,  parable.  This  should  be 
practised  for  wreeks  or  months  upon  every  word,  which  the  stam- 
merer hesitates  in  pronouncing.  To  this  should  be  added  much 
commerce  with  mankind,  in  order  to  acquire  a carelessness  about 
the  opinions  of  others. 

2.  Chorea  St.  Viti.  In  the  St.  Vitus’s  dance  the  patient  can 
at  any  time  lie  still  in  bed,  which  shews  the  motions  not  to  be 
convulsive;  and  he  can  at  different  times  voluntarily  exert  every 
muscle  of  his  body;  which  evinces,  that  they  are  not  paralytic. 
In  this  disease  the  principal  muscle  in  any  designed  motion  obeys 
the  will;  but  those  muscles,  whose  motions  were  associated  with 
the  principal  one,  do  not  act;  as  their  association  is  dissevered, 
and  thus  the  arm  or  leg  is  drawn  outward,  or  inward,  or  back- 
ward, instead  of  upward  or  forward,  with  various  gesticulations 
exactly  resembling  the  impediment  of  speech. 

This  disease  is  frequently  left  after  the  itch  has  been  too  hastily 
cured.  See  convulsio  dolorifica,  Class  III.  1.  1.  6.  A girl 
about  eighteen,  after  wearing  a mercurial  girdle  to  cure  the  itch, 


424 


DISEASES 


Class  IV.  2.  3.  3-. 

acquired  the  chorea  St.  Viti  in  so  universal  a manner,  that  her 
speech  became  affected  as  well  as  her  limbs;  and  there  was  evi- 
dently a disunion  of  the  common  trains  of  ideas;  as  the  itch 
was  still  among  the  younger  children  of  the  family,  she  was  ad- 
vised to  take  her  sister  as  a bedfellow,  and  thus  received  the  itch 
again;  and  the  dance  of  St.  Vitus  gradually  ceased.  See  Class 

II.  1 . 5.  6. 

M.  M.  Give  the  patient  the  itch  again.  Calomel  a grain 
every  night,  or  sublimate  a quarter  of  a grain  twice  a day  for  a 
fortnight.  Steel.  Bark.  Warm  bath.  Cold  bath.  Opium. 
Venesection  once  at  the  beginning  of  the  disease.  Electricity. 
Perpetual,  slow  and  repeated  efforts  to  move  each  limb  in  the  de- 
signed direction,  as  in  the  titubatio  linguae  above  described. 

3.  Risus.  Laughter  is  a perpetual  interruption  of  voluntary 
exertion  by  the  interposition  of  pleasurable  sensation;  which  not 
being  checked  by  any  important  consequences  rises  into  pair, 
and  requires  to  be  relieved  or  moderated  by  the  frequent  repeti- 
tion of  voluntary  exertion.  See  Sect.  XXXIV.  1.  4.  and  Class 

III.  1.  1.  4.  and  IV.  1.  3.  3. 

4.  Tremor  ex  ird.  The  trembling  of  the  limbs  from  anger. 
The  interruption  of  the  voluntary  associations  of  motions  by  an- 
ger, originates  from  too  great  a part  of  the  sensorial  power  being 
exerted  on  the  organs  of  sense;  whence  the  muscles,  which  ought 
to  support  the  body  upright,  are  deprived  of  their  due  quantity, 
and  tremble  from  debility.  See  Class  III.  2.  1.  1. 

5.  Rubor  ex  ird.  Redness  from  anger.  Anger  is  an  excess 
of  aversion,  that  is,  of  voluntarily  not  yet  employed.  It  is  excited 
by  the  pain  of  offended  pride;  when  it  is  employed  it  becomes 
outrage,  cruelty,  insanity.  The  cutaneous  capillaries,  especially 
those  of  the  face,  are  more  mobile,  that  is,  more  easily  excited 
into  increased  action,  or  more  easily  become  torpid,  from  less 
variation  of  sensorial  powrer,  than  any  other  parts  of  the  system, 
which  is  owing  to  their  being  perpetually  subject  to  the  vicissi- 
tudes of  heat  and  cold,  and  of  extension  and  corrugation.  Hence, 
when  an  excess  of  voluntarity  exists  without  being  immediately 
expended  in  the  actions  of  the  large  muscles,  the  capillary  arteries 
and  glands  acquire  more  energetic  action,  and  a flushed  skin  is 
produced,  with  increased  secretion  of  perspirable  matter,  and 
consequent  heat,  owing  to  the  pause  or  interruption  of  voluntary 
action;  and  thus  the  actions  of  these  cutaneous  vessels  become 
associated  between  the  irascent  ideas  and  irascent  muscular  ac- 
tions, which  are  thus  for  a time  interrupted. 

6.  Rubor  crimmati.  The  blushing  of  accused  people,  whether 
guilty  or  not,  appears  to  be  owing  to  circumstances  similar  to 


Cxass  IV.  2.  3.7. 


OF  ASSOCIATION". 


425 


that  of  anger;  for  in  these  situations  there  is  always  a sudden 
voluntarity,  or  wish,  of  clearing  their  characters  arises  in  the 
mind  of  the  accused  person;  which,  before  an  opportunity  is 
given  for  it  to  be  expended  on  the  large  muscles,  influences  the 
capillary  arteries  and  glands,  as  in  the  preceding  article.  Whence 
the  increased  actions  of  the  capillaries,  and  the  consequent  red- 
ness and  heat,  become  exerted  between  the  voluntary  ideas  of 
self-defence,  and  the  muscular  actions  necessary  for  that  purpose; 
which  last  are  thus  for  a time  interrupted  or  delayed. 

Even  in  the  blush  of  modesty  or  bashfulness  there  is  a self- 
condemnation  for  some  supposed  defect  or  indecorum,  and  a 
suddenly  voluntarity,  or  wish,  of  self-defence;  which,  not  being- 
expended  in  actions  of  the  larger  muscles,  excites  the  capillaries 
into  action;  which  in  these  subjects  are  more  mobile  than  in 
others. 

The  blush  of  young  girls  on  coming  into  an  assembly-room, 
where  they  expect  their  dress,  and  steps,  and  manner,  to  be  ex- 
amined, as  in  dancing  a minuet,  may  have  another  origin;  and 
may  be  considered  as  a hot  fit  of  returning  confidence  after  a 
previous  cold  fit  of  fear. 

7.  Tarditas  paralytica.  By  a stroke  of  the  palsy  or  apoplexy 
it  frequently  happens  that  those  ideas  which  were  associated  iu 
trains,  whose  first  link  was  a voluntary  idea,  have  their  connection 
dissevered;  and  the  patient  is  under  the  necessity,  by  repeated 
efforts,  slowly  to  renew  their  associations.  In  this  situation  those 
words,  which  have  the  fewest  other  words  associated  with  them, 
as  die  proper  names  of  persons  or  places,  are  the  most  difficult 
to  recollect.  And  in  those  efforts  of  recollection  the  word  op- 
posite to  the  word  required  is  often  produced,  as  hot  for  cold, 
winter  for  summer,  which  is  owing  to  our  associating  our  ideas 
of  things  by  their  opposites  as  well  as  by  their  similitudes,  and 
in  some  instances  perhaps  more  frequently,  or  more  forcibly. 
Other  paralytic  patients  are  liable  to  give  wrong  names  to  exter- 
nal objects,  as  using  the  word  pigs  for  sheep,  or  cows  for  horses; 
in  this  case  the  association  between  the  idea  of  the  animal  and 
the  name  of  it  is  dissevered;  but  the  idea  of  the  class  or  genus  of 
the  thing  remains;  and  he  takes  a name  from  the  first  species 
which  presents  itself,  and  sometimes  can  correct  himself,  till  he 
finds  the  true  one. 

8.  Tarditas  senilis.  Slowness  of  age.  The  difficulty  of  asso- 
ciating ideas  increases  with  our  age;  as  may  be  observed  from 
old  people  forgetting  the  business  of  the  last  hour,  unless  they 
impress  it  strongly,  or  by  frequent  repetition,  though  they  can 
well  recollect  the  transactions  of  their  youth.  I saw  an  elderly 
man  who  could  reason  with  great  clearness  and  precision,  and 

VOL.  II.  3 i 


426 


DISEASES 


Class  IV.  2.  3.  8. 


in  accurate  language  on  subjects,  which  he  had  been  accustomed 
to  think  upon;  and  yet  did  not  know  that  he  had  rung  the  bell 
by  his  fire-side  in  one  minute  afterwards;  nor  could  then  recollect 
the  object  he  had  wanted,  when  his  servant  came. 

Similar  to  this  is  the  difficulty  which  old  people  experience  in 
learning  new  bodily  movements,  that  is,  in  associating  new  mus- 
cular actions,  as  in  learning  a new  trade  or  manufacture.  The 
trains  of  movements,  which  obey  volition,  are  the  last  which  vvc 
acquire;  and  the  first  which  are  dissociated. 

The  symbols  most  in  use,  with  which  we  have  associated  ideas, 
are  those  of  visible  and  of  audible  language.  It  is  curious  to  ob- 
serve in  the  instruction  of  young  people,  that  some  remember 
written  language  the  best,  and  others  vocal  language.  The  same 
thing  sometimes  occurs  in  aged  people,  that  is,  that  some  lose 
the  ideas  associated  with  sounds  soonest,  and  others  those  asso- 
ciated with  letters.  See  recollectionis  jactura,  Class  III.  2.  2.  1. 
and  Tarditas  paralytica  above. 

The  following  curious  account  of  this  defect  of  association  of 
ideas  with  audible  but  not  with  visible  symbols  wras  sent  me  by 
Dr.  Darwin  of  Shrewsbury. 

“ The  case  of  an  old  man  lately  occurred  to  me,  wrho  was  su- 
perannuated; his  hearing  and  vision  wTere  perfect,  but  be  could 
only  call  up  a train  of  ideas  from  the  latter.  When  he  was  told 
it  was  nine  o’clock,  and  time  for  him  to  eat  his  breakfast,  he  re- 
peated the  words  distinctly  but  without  understanding  them. 
His  servant  put  a watch  into  his  hand.  ‘ Why,  illiam,  have 
not  I my  breakfast,  for  it  is  just  nine  o’clock?’  he  would  say  with 
expression,  that  shewed  he  felt  what  he  said. 

“ On  almost  every  occasion  his  servants  conversed  with  him 
by  visible  objects  although  his  hearing  was  perfect;  and  when 
this  kind  of  communication  was  used,  he  did  not  appear  impaired 
in  his  intellects.  This  state  came  on  from  a stroke  of  the  palsy; 
and  till  he  and  his  attendants  used  this  kind  of  language  he  was 
quite  childish.” 


CtAss  IV.  2.  4. 


OF  ASSOCIATION'. 


427 


ORDO  II. 

I 

Decreased  Associate  Motions. 

GENUS  IY. 

Catenated  with  External  Influences. 

As  the  diseases,  which  obey  solar  or  lunar  periods,  commence 
with  torpor  or  inactivity,  such  as  the  cold  paroxysms  of  fevers,  the 
torpor  and  consequent  pain  of  hemicrania,  and  the  pains  which 
precede  the  fits  of  epilepsy  and  convulsion,  it  would  seem,  that 
these  diseases  are  more  generally  owing  to  the  diminution  than 
to  the  excess  of  solar  or  lunar  gravitation;  as  the  diseases  which 
originate  from  the  influence  of  the  matter  of  heat,  are  much  more 
generally  in  this  country  produced  by  the  defect  than  by  the  ex- 
cess of  that  fluid. 

The  periodic  returns  of  so  many  diseases  coincide  with  the 
diurnal,  monthly,  and  annual  rounds  of  time;  that  any  one,  who 
■would  deny  the  influence  of  the  sun  and  moon  on  the  periods  of 
quotidian,  tertian,  and  quartan  fevers,  must  deny  their  effect  on 
the  tides,  and  on  the  seasons.  It  has  generally  been  believed,  that 
solar  and  lunar  effect  was  exerted  on  the  blood;  which  was  thus 
rendered  more  or  less  stimulant  to  the  system,  as  described  in 
Sect.  XXXII.  6.  But  as  the  fluid  matter  of  gravitation  per- 
meates and  covers  all  things,  like  the  fluid  matter  of  heat;  I am 
induced  to  believe,  that  gravitation  acts  in  its  medium  state 
rather  as  a causa  sine  qua  non  of  animal  motion  like  heat;  which 
may  disorder  the  system  chemically  or  mechanically,  when  it  is 
diminished;  but  may  nevertheless  stimulate  it,  when  increased, 
into  animal  exertion. 

Without  heat  and  motion,  which  some  philosophers  still  be- 
lieve to  be  the  same  thing,  as  they  so  perpetually  appear  together, 
the  particles  of  matter  wrould  attract  and  move  towards  each 
other,  and  the  whole  universe  freeze  or  coalesce  into  one  solid 
mass.  These  therefore  counteract  the  gravitation  of  bodies  to 
one  centre;  and  not  only  prevent  the  planets  from  falling  into 
the  sun,  but  become  either  the  efficient  causes  of  vegetable  and 
animal  life,  or  the  causes  without  which  life  cannot  exist;  as  by 
their  means  the  component  particles  of  matter  are  enabled  to 
slide  over  each  other  with  all  the  various  degrees  of  fluidity  and 
repulsion. 

As  the  attraction  of  the  moon  countervails  or  diminishes  the 
terrene  gravitation  of  bodies  on  the  surface  of  the  earth:  a tide 


428 


DISEASES 


Class  IV.  2.  4. 


rises  on  that  side  of  the  earth,  which  is  turned  towards  the 
moon;  and  follows  it,  as  the  earth  revolves.  Another  tide  is 
raised  at  the  same  time  on  the  opposite  side  of  the  revolving 
earth,  which  is  owing  to  the  greater  centrifugal  motion  of  that 
side  of  the  earth,  which  counteracts  the  gravitation  of  bodies 
near  its  surface.  For  the  earth  and  moon  may  be  considered  as 
two  cannon  balls  of  different  sizes  held  together  by  a chain,  and 
revolving  once  a month  round  a common  centre  of  gravity  be- 
tween them,  near  the  earth’s  surface;  at  the  same  time  that  they 
perform  their  annual  orbits  round  the  sun.  Whence  the  cen- 
trifugal force  of  that  side  of  the  earth,  which  is  farthest  from  < his 
centre  of  motion,  round  which  the  earth  and  moon  monthly  re- 
volve, is  considerably  greater,  than  the  centrifugal  force  of  that 
side  of  the  earth  which  is  nearest  it;  to  which  should  be  added, 
that  this  centrifugal  force  not  only  contributes  to  diminish  die 
terrene  gravitation  of  bodies  on  the  earth’s  surface  on  that  side 
furthest  from  the  centre  of  motion,  but  also  to  increase  it  on  .hat 
side,  which  is  nearest  it. 

Another  circumstance,  which  tends  to  raise  the  tide  on  the 
part  of  the  earth’s  surface,  which  is  most  distant  from  the  moon, 
is,  that  the  attraction  of  the  moon  is  less  on  that  part  of  the 
ocean,  than  it  is  on  the  other  parts  of  the  earth.  Thus  the  moon 
may  be  supposed  to  attract  the  water  on  the  side  of  the  earth 
nearest  it  with  a power  equal  to  three;  and  to  attract  the  central 
parts  of  the  earth  with  a power  equal  to  two;  and  the  water  on 
the  part  of  the  earth  most  distant  from  the  moon  with  a power 
only  equal  to  one.  Hence  on  the  side  of  the  earth  most  distant 
from  the  moon,  the  moon’s  attraction  is  less,  and  the  centrifugal 
force  round  their  common  centre  of  motion  is  greater;  both  which 
contribute  to  raise  the  tides  on  that  side  of  the  earth,  On  the  side 
of  the  earth  nearest  the  moon,  the  moon’s  attraction  is  so  much 
greater  as  to  raise  the  tides;  though  the  centrifugal  force  of  the 
surface  of  the  earth  round  their  common  centre  of  motion  in 
some  degree  opposes  this  effect. 

On  these  accounts,  when  the  moon  is  in  the  zenith  or  nadir, 
the  gravitation  of  bodies  on  the  earth’s  surface  will  be  greatest 
at  the  two  opposite  quadratures;  that  is,  the  greatest  gravitation 
of  bodies  on  the  earth’s  surface  towards  her  centre  during  the 
lunar  day  is  about  six  hours  and  a half  after  the  southing,  or  after 
the  northing  of  the  moon. 

Circumstances  similar  to  these,  but  in  a less  degree,  must  oc- 
cur in  respect  to  the  solar  influence  on  terrestrial  bodies;  that 
is,  there  must  be  a diminution  of  the  gravity  of  bodies  near 
the  earth’s  surface  at  noon,  when  the  sun  is  over  them;  and  also 
at  midnight  from  the  greater  centrifugal  force  of  that  side  of 


C,lass  IV.  2.  4.  1. 


OP  ASSOCIATION. 


429 


the  earth,  which  is  most  distant  from  the  centre,  round  which  the 
earth  moves  in  her  annual  orbit,  than  on  the  side  nearest  that 
centre.  Whence  it  likewise  follows,  that  the  gravitation  of  bo- 
dies towards  the  earth  is  greatest  about  six  hours  after  noon,  and 
after  midnight. 

Now  when  the  sun  and  moon  have  their  united  gravitation  on 
the  same  side  of  the  earth,  as  at  the  new  moon;  or  when  the  solar 
attraction  coincides  w'ith  the  greater  centrifugal  motion  of  that 
side  of  the  earth,  which  is  furthest  distant  from  the  moon,  as  at 
the  full  moon;  and  when  this  happens  about  noon  or  midnight, 
the  gravitation  of  terrene  bodies  towards  the  earth  will  be  greater 
about  six  hours  after  noon,  and  after  midnight,  than  at  any  other 
part  of  the  lunar  period;  because  the  attraction  of  both  these 
luminaries  is  then  exerted  on  those  sides  of  the  earth  over  which 
they  hang,  which  at  other  times  of  the  month  are  more  or  less  ex- 
erted on  other  parts  of  it. 

Lastly,  as  heat  and  motion  counteract  the  gravitation  of  the 
particles  of  bodies  to  each  other,  and  hence  become  either  the 
efficient  causes  of  vegetable  and  animal  life,  or  the  causes  with- 
out which  life  cannot  exist,  it  seems  to  follow,  that  when  our 
gravitation  towards  the  earth’s  centre  is  greatest,  the  powers  of 
life  should  be  the  least;  and  hence  that  those  diseases,  which 
begin  with  torpor,  should  occur  about  six  hours  after  the  solar  or 
lunar  noon,  or  about  six  hours  after  the  solar  or  lunar  midnight; 
and  this  most  frequently  about  six  hours  after  or  before  the  new 
or  full  moon;  and  especially  when  these  happen  at  noon  or  at 
midnight;  or  lastly,  according  to  the  combination  of  these  powers 
in  diminishing  or  increasing  the  earth’s  attraction  to  bodies  on  its 
surface. 

The  returns  or  exacerbations  of  many  fevers,  both  irritative  and 
inflammatory,  about  six  in  the  evening,  and  of  the  periodic  cough 
described  in  Sect.  XXXVI.  3.  9.  countenance  this  theory.  Tables 
might  be  made  out  to  shew  the  combined  powers  of  the  sun  and 
moon  in  diminishing  the  gravitation  of  bodies  on  the  earth’s  sur- 
face, at  every  part  of  their  diurnal,  monthly,  and  annual  periods; 
and  which  might  facilitate  the  elucidation  of  this  subject.  But  I 
am  well  aware  of  the  difficulty  of  its  application  to  diseases,  and 
hope  these  conjectures  may  induce  others  to  publish  more  nume- 
rous observations,  and  more  conclusive  reasonings. 

SPECIES. 

1 . Somni  periodus.  The  periods  of  sleeping  and  of  waking  are 
shortened  or  prolonged  by  so  many  other  circumstances  in  animal 
life,  besides  the  minute  difference  between  diurnal  and  nocturnal 


430 


DISEASES 


Class  IV.  2.  4.  2. 


solar  gravitation,  that  it  can  scarcely  be  ascribed  to  this  influence. 
At  the  same  time,  it  is  curious  to  observe,  that  vegetables,  in  re- 
spect to  their  times  of  sleeping,  more  regularly  observe  the  hour 
of  the  day,  than  the  presence  or  absence  of  light,  or  of  heat,  as 
may  be  seen  by  consulting  the  calender  of  Flora.  Botanic  Gar- 
den, Part  II.  Canto  2.  1.  165.  note. 

Some  diseases,  which  at  first  sight  might  be  supposed  to  be  in- 
fluenced by  solar  periods,  seem  to  be  induced  by  the  increasing 
sensibility  of  the  system  to  pain  during  our  sleeping  hours;  as 
explained  in  Sect.  XVIII.  15.  Of  these  are  the  fits  of  asthma, 
of  some  epilepsies,  and  of  some  haemoptoes;  all  which  disturb  the 
patient  after  some  hours  sleep,  and  are  therefore  to  be  ascribed 
to  the  increase  of  our  dormant  sensibility.  There  may  likewise 
be  some  doubt,  whether  the  commencement  of  the  pain  of  gout 
in  the  foot,  as  it  generally  makes  its  attack  after  sleep,  should  be 
ascribed  to  the  increased  sensibility  in  sleep,  or  to  solar  influ- 
ence? 

M.  M.  When  asthmatic  or  epileptic  fits,  or  haemoptoe,  occur 
after  a certain  number  of  hours  of  sleep,  the  patient  should  be 
forcibly  awakened  before  the  expected  time  by  an  alarm  clock, 
and  drink  a cup  of  chocolate  or  lemonade. — Or  a grain  of  opium 
should  be  given  at  going  to  bed. — In  one  case  to  prevent  the  too 
great  increase  of  sensibility  by  shortening  the  time  of  sleep;  and 
in  the  other  by  increasing  the  irritative  motions,  and  expending 
by  that  means  a part  of  the  sensorial  power. 

2.  Studii  inanis periodus.  Class  III.  1.  2.  2.  The  cataleptic 
spasm  which  preceded  the  reverie  and  somnambulation  in  the  pa- 
tient, whose  case  is  related  in  Sect.  XIX.  2.  occurred  at  exactly 
the  same  hour,  which  was  about  eleven  in  the  morning  for  many 
weeks;  till  those  periods  were  disturbed  by  large  doses  of  opium; 
and  must  therefore  be  referred  to  some  effect  of  solar  gravitation. 
In  the  case  of  Master  A.  Sect.  XXXIV.  3.  as  the  reverie  began 
early  in  the  morning  during  sleep,  there  may  be  a doubt,  whether 
this  commenced  with  torpor  of  some  organ  catenated  with  solar 
gravitation;  or  was  caused  by  the  existence  of  a previous  torpid 
part,  which  only  became  so  painful  as  to  excite  the  exertions  ol 
reverie  by  the  perpetual  increase  of  sensibility  during  the  conti- 
nuance of  sleep,  as  in  some  fits  of  epilepsy,  asthma,  and  ha?mop- 
toe,  mentioned  in  the  preceding  article. 

3.  Hemicran'ue periodus.  Periods  of  hemicrania.  Class  H . 
2.  2.  8.  The  torpor  and  consequent  pain  of  some  membranes 
on  one  side  of  the  head,  as  over  one  eye,  are  frequently  occa- 
sioned by  a decaying  tooth,  and  are  liable  to  return  every  day, 
or  on  alternate  days  at  solar  or  lunar  periods.  In  this  case  large 
quantities  of  the  bark  will  frequently  cure  the  disease,  and 


Class  IV.  2.  2.  4. 


OF  ASSOCIATION". 


43! 


especially  if  preceded  by  venesection  and  a brisk  cathartic;  but  if 
the  otfending  tooth  can  be  detected,  the  most  certain  cure  is  its 
extraction.  These  partial  head-achs  are  also  liable  to  return  at 
the  greater  lunar  periods,  as  about  once  a month.  Five  drops 
from  a two  ounce  phial  of  a saturated  solution  of  arsenic  twice 
a day  for  a week  or  two  have  been  said  to  prevent  the  returns  of 
this  disease.  See  a Treatise  on  Arsenic  by  Dr.  Fowler,  of  York. 
Strong  errhines  have  also  been  recommended. 

4.  Epilepsia  dolorijica  periodus.  Class  III.  1.  1.  8.  The  pain 
which  induces  after  about  an  hour  the  violent  convulsions  or  in- 
sanity, which  constitute  the  painful  epilepsy,  generally  observe 
solar  diurnal  periods  for  four  or  five  weeks,  and  are  probably 
governed  by  solar  and  lunar  times  in  respect  to  their  greater  pe- 
riods; for  I have  observed  that  the  daily  paroxysms,  unless  dis- 
turbed by  large  doses  of  opium,  recur  at  very  nearly  the  same 
hour,  and  after  a few  weeks  the  patients  have  recovered  to  re- 
lapse again  at  the  interval  of  a few  months.  But  more  obser- 
vations are  wanted  upon  this  subject,  which  might  be  of  great 
advantage  in  preventing  the  attacks  of  this  disease;  as  much  less 
opium  given  an  hour  before  its  expected  daily  return  will  pre- 
vent the  paroxysm,  than  is  necessary  to  cure  it,  after  it  has  com- 
menced. 

5.  Convulsionis  dolorijica  periodus.  Class  III.  1.  1.  6.  The 
pains,  which  produce  these  convulsions,  are  generally  ieft  after 
rheumatism,  and  come  on  when  the  patients  are  become  warm 
in  bed,  or  have  been  for  a short  time  asleep,  and  are  therefore 
perhaps  rather  to  be  ascribed  to  the  increasing  sensibility  of  the 
system  during  sleep,  than  to  solar  diurnal  periods,  as  in  Species 
first  and  second  of  this  Genus. 

6.  Tussis  periodica  periodus.  Periodic  cough,  Class  IV.  2.  1. 
9.  returns  at  exact  solar  periods;  that  described  in  Sect.XXXVI, 
3.  9.  recurred  about  seven  in  the  afternoon  for  several  weeks, 
till  its  periods  were  disturbed  by  opium,  and  then  it  recurred  at 
eleven  at  night  for  about  a week,  and  was  then  totally  destroyed 
by  opium  given  in  very  large  quantities,  after  having  been  pre- 
viously for  a few  days  omitted. 

7.  Catamenia  periodus.  Periods  of  menstruation.  The  cor- 
respondence of  the  periods  of  the  catamenia  with  those  of  the 
moon  was  treated  of  in  Sect.  XXXII.  8.  and  can  admit  of  no 
more  doubt,  than  that  the  returns  of  the  tides  are  governed  by 
lunar  influence.  But  the  manner  in  which  this  is  produced,  is 
less  evident;  it  has  commonly  been  ascribed  to  some  effect  of 
the  lunar  gravitation  on  the  circulating  blood,  as  mentioned  in 
Sect.  XXXII.  6.  But  it  is  more  analogous  to  other  animal 
phenomena  to  suppose  that  the  lunar  gravitation  immediately 


432 


DISEASES 


Class  IV.  2 4.  S. 


affects  the  solids  by  its  influx  or  stimulus.  Which  we  believe 
of  the  fluid  element  of  heat,  in  which  we  are  equally  immersed; 
and  of  the  electric  fluid,  which  also  surrounds  and  pervades  us. 
See  Sect.  XXXVI.  2.  3. 

If  the  torpor  of  the  uterine  veins,  which  induces  the  monthly 
periods  of  the  catamenia,  be  governed  by  the  increase  of  terrene 
gravitation;  that  is,  by  the  deficiency  of  the  counter-influence 
of  solar  and  lunar  gravitation;  why  does  not  it  occur  most  fre- 
quently when  the  terrene  gravitation  is  the  greatest,  as  about  six 
hours  after  the  new  moon,  and  next  to  that  at  about  six  hours  after 
the  full  moon?  This  question  has  its  difficulty;  first,  if  the  ter- 
rene gravitation  be  greatest  about  six  hours  after  the  new  moon, 
it  must  become  less  and  less  about  the  same  time  every  lunar  day, 
till  the  end  of  the  first  quarter,  when  it  will  be  the  least;  it  must 
then  increase  daily  till  the  full.  After  the  full  the  terrene  gravi- 
tation must  again  decrease  till  the  end  of  the  third  quarter, 
when  it  will  again  be  the  least,  and  must  increase  again  till  the 
new  moon;  that  is,  the  solar  and  lunar  counter-gravitation  is 
greatest,  when  those  luminaries  are  vertical,  at  the  new  moon, 
and  full  moon,  and  least  about  six  hours  afterwards.  If  it  was 
known,  whether  more  menstruations  occur  about  six  hours  after 
the  moon  is  in  the  zenith  or  nadir;  and  in  the  second  and 
fourth  quarters  of  the  moon,  than  in  the  first  and  third;  some 
light  would  be  thrown  on  this  subject;  which  must  in  that  re- 
spect wait  for  future  observations. 

Secondly,  if  the  lunar  influence  produces  a very  small  degree 
of  quiescence,  suppose  of  the  uterine  veins,  at  first;  and  if  that 
recurs  at  certain  periods,  as  of  lunar  days,  or  about  25  hours, 
even  with  less  power  to  produce  quiescence  than  at  first:  yet 
the  quiescence  will  daily  increase  by  the  acquired  habit  acting 
at  the  same  time,  as  explained  in  Sect.  XII.  3.  3.  till  at  length 
so  great  a degree  of  quiescence  will  be  induced  as  to  cause  the 
inaction  of  the  veins  of  the  uterus,  and  consequent  venous  hae- 
morrhage. See  Sect.  XXXII.  6.  Class  I.  2.  1.  II.  IV.  1.  4.  4. 
See  the  introduction  to  this  Genus. 

8.  Hmnorrhoidis  periodus.  The  periods  of  the  piles  depend 
on  the  torpor  of  the  veins  of  the  rectum,  and  are  believed  to  re- 
cur nearly  at  monthly  intervals.  See  Sect.  XX^  II.  2.  and 
Class  1.  2.  1.  6. 

9.  Podagroe.  periodus.  The  periods  of  gout  in  some  patients 
recur  at  annual  intervals,  as  in  the  case  related  above  in  Class 
IV.  1.  2.  15.  in  which  the  gouty  paroxysm  returned  for  three 
successive  years  on  nearly  the  same  day  of  the  month.  The 
commencement  of  the  pain  of  each  paroxysm  is  generally  a few 
hours  after  midnight,  and  may  thence  either  be  induced  by 


Class  IV.  2. 4.  10.  OF  ASSOCIATION.  433 

diurnal  solar  periods,  or  by  the  increasing  sensibility  during  sleep, 
as  mentioned  in  the  first  species  of  this  genus. 

10.  Erysipelatis  periodus.  Some  kinds  of  erysipelas,  which 
probably  originate  from  the  association  of  the  cutaneous  vessels 
with  a diseased  liver,  occur  at  monthly  periods,  like  the  haemor- 
rhois  or  piles;  and  others  at  annual  periods,  like  the  gout;  as  a 
torpor  of  some  part  I suppose  always  precedes  the  erysipelatous 
inflammation,  the  periods  should  accord  with  the  increasing  in- 
fluence of  terrene  gravitation,  as  described  in  the  introduction  to 
this  Genus,  and  in  species  the  seventh  of  it.  Other  periods  of 
diseases  referrible  to  solar  and  lunar  influence,  are  mentioned  in 
Section  XXXVI.  and  many  others  will  probably  be  discovered  by 
future  observation. 

11.  Febrium  periodus.  Periods  of  fevers.  The  commence- 
ment of  the  cold  fits  of  intermittent  fevers,  and  the  daily  exacer- 
bations of  other  fevers,  so  regularly  recur  at  diurnal,  solar,  or 
lunar  periods,  that  it  is  impossible  to  deny  their  connection  with 
gravitation;  as  explained  in  Sect.  XXXVI.  3.  Not  only  these 
exacerbations  of  fever,  and  their  remissions,  and  the  diurnal  so- 
lar and  lunar  periods;  but  the  preparatory  circumstances,  which 
introduce  fevers,  or  which  determine  their  crisis,  appear  to  be 
governed  by  the  parts  of  monthly  lunar  periods,  and  of  solar  an- 
nual ones.  Thus  the  variolous  fever  in  the  natural  small -pox 
commences  on  the  14th  day,  and  in  the  inoculated  small-pox  on 
the  seventh  day.  The  fever  and  eruption  in  the  distinct  kind 
take  up  another  quarter  of  a lunation,  and  the  maturation  ano- 
ther quarter. 

The  fever,  which  is  termed  canine  madness,  or  hydrophobia, 
is  believed  to  commence  near  the  new  or  full  moon;  and,  if  the 
cause  is  not  then  great  enough  to  bring  on  the  disease,  it  seems  to 
acquire  some  strength,  or  to  lie  dormant,  till  another,  or  perhaps 
more  powerful  lunation  calls  it  into  action.  In  the  spring,  about 
three  or  four  years  ago,  a mad  dog  very  much  worried  one  swine, 
confined  in  a sty,  and  bit  another  in  the  same  sty  in  a less  degree; 
the  former  became  mad,  refused  his  meat,  was  much  convulsed, 
and  died  in  about  four  days;  this  disease  commenced  about  a 
month  after  the  bite.  The  other  swine  began  to  be  ill  about  a 
month  after  the  first,  and  died  in  the  same  manner. 


VOL.  II, 


3 K 


434 


DISEASES 


Class  IV.  3. 1.  1. 


ORDO  III. 

Retrograde  dissociate  Motions. 

GENUS  I. 

Catenated  with  Irritative  Motions. 

Those  retrograde  associate  motions,  the  first  links  of  which 
are  catenated  with  irritative  motions,  belong  to  this  genus.  All 
the  retrograde  motions  are  consequent  to  debility,  or  inactivity, 
of  the  organ;  and  therefore  properly  belong  to  the  genera  of  de- 
creased actions,  both  in  this  and  the  former  classes. 

SPECIES. 

1.  Diabetes  irritata.  When  the  absorbents  of  the  intestines 
are  stimulated  too  strongly  by  spirit  of  wine,  as  in  the  beginning 
of  drunkenness,  the  urinary  absorbents  invert  their  motions. 
The  same  happens  from  worms  in  the  intestines.  In  other 
kinds  of  diabetes  may  not  the  remote  cause  be  the  too  strong 
action  of  the  cutaneous  absorbents,  or  of  the  pulmonary  ones? 
May  not  in  such  cases  oil  externally  or  internally  be  of  service? 
or  warm  bathing  for  an  hour  at  a time?  In  hysteric  inversions 
of  motion,  is  some  other  part  too  much  stimulated?  or  pained 
from  the  want  of  stimulus? 

2.  Sudor  frigidus  in  asthmate.  The  cause  of  the  paroxysms 
of  humoral  asthma  is  not  well  understood;  1 suppose  it  to  be  ow- 
ing to  a torpidity  or  inaction  of  the  absorbents  belonging  to  the 
pulmonary  vessels,  as  happens  probably  to  other  viscera  at  the 
commencement  of  intermittent  fevers,  and  to  a consequent  accu- 
mulation of  fluids  in  them;  which  at  length,  producing  great  irri- 
tation or  uneasy  sensation,  causes  the  violent  efforts  to  produce 
the  absorption  of  it.  The  motions  of  the  cutaneous  absorbent 
vessels  by  their  association  with  those  of  the  pulmonary  ones  be- 
come retrograde,  and  effuse  upon  the  skin  a fluid,  which  is  said 
to  be  viscid,  and  which  adheres  in  drops. 

A few  days  ago  I saw  a young  man  of  delicate  constitution,  in 
what  was  called  a fit  of  the  asthma;  he  had  about  two  months 
before  had  a peripneumony,  and  had  been  ever  since  subject  to 
difficult  respiration  on  exertion,  with  occasional  palpitation  of 
his  heart.  He  was  now  seized  about  eight  at  night  after  some 
exertion  of  mind  in  his  business  with  cold  extremities,  and  diffi- 
culty of  breathing.  He  gradually  became  worse,  and  in  about 


Glass  IV.  3.  1.  3, 


OF  ASSOCIATION. 


435 


half  an  hour,  the  palpitation  of  his  heart  and  difficult  respiration 
were  very  alarming;  his  whole  skin  was  cold  and  pale,  yet  he 
did  not  shudder  as  in  cold  paroxysm  of  fever;  his  tongue  from 
the  point  to  the  middle  became  as  cold  as  his  other  extremities, 
with  cold  breath.  He  seemed  to  be  in  the  act  of  dying,  except 
that  his  pulse  continued  equal  in  time,  though  very  quick.  He 
lost  three  ounces  of  blood,  and  took  ten  drops  of  laudanum,  with 
musk  and  salt  of  hartshorn,  and  recovered  in  an  hour  or  two 
without  any  cold  sweat. 

There  being  no  cold  sweat  seems  to  indicate  that  there  was 
no  accumulation  of  serous  fluid  in  the  lungs;  and  that  their 
inactivity,  and  the  coldness  of  the  breath,  was  owing  to  the 
sympathy  of  the  air-cells  with  some  distant  part.  There  was 
no  shuddering  produced,  because  the  lungs  are  not  sensible  to 
heat  and  cold;  as  any  one  may  observe  by  going  from  a warm 
room  into  a frosty  air,  and  the  contrary.  So  the  steam  of  hot 
tea,  which  scalds  the  mouth,  does  not  affect  the  lungs  with  the 
sensation  of  heat.  I was  induced  to  believe  that  the  whole  cold 
fit  might  be  owing  to  suppuration  in  some  part  of  the  chest;  as 
the  general  difficulty  of  breathing  seemed  to  be  increased  after  a 
few  days  with  pulse  of  120,  and  other  signs  of  empyema.  Do 
the  cold  sweat,  and  the  occurrence  of  the  fits  of  asthma  after 
sleep,  distinguish  the  humoral  asthma  from  the  cold  paroxysm  of 
intermittents,  or  that  which  attends  suppuration,  or  which  pre- 
cedes inflammation  ? — 1 heard  a few  weeks  afterwards,  that  he 
spit  up  much  matter  at  the  time  he  died. 

3.  Diabetes  a timore.  The  motions  of  the  absorbent  vessels  of 
the  neck  of  the  bladder  become  inverted  by  their  consent  with 
those  of  the  skin;  which  are  become  torpid  by  their  reverse 
sympathy  with  the  painful  ideas  of  fear,  as  in  Section  XVI.  8.  1. 
whence  there  is  a great  discharge  of  pale  urine,  as  in  hysteric 
diseases. 

The  same  happens  from  anxiety,  where  the  painful  suspense 
is  continued,  even  when  the  degree  of  fear  is  small;  as  in  young 
men  about  to  be  examined  for  a degree  at  the  universities,  the 
frequency  of  making  water  is  very  observable.  When  this  anxiety 
is  attended  with  a sleepless  night,  the  quantity  of  pale  urine 
is  amazingly  great  in  some  people,  and  the  micturition  very  fre- 
quent. 

M.  M.  Opium.  Joy.  Consolations  of  friendship. 

4.  Diarrhoea  a timore.  The  absorbent  vessels  of  the  intestines 
invert  their  motions,  by  direct  consent  with  the  skin;  hence 
many  liquid  stools  as  well  as  much  pale  urine  are  liable  to  ac- 
company continued  fear,  along  with  coldness  of  the  skin.  The 
immediate  cause  of  this  is  the  decreased  sensorial  power  of  asso- 


436 


DISEASES 


Class  IV.  3.  1.  5. 


ciation,  which  intervenes  between  the  actions  of  the  absorbents 
of  the  cold  skin,  and  those  of  the  intestinal  absorbents;  the  mo- 
tions of  the  latter  become  on  that  account  weakened  and  at 
length  retrograde.  The  remote  cause  is  the  torpor  of  the  ves- 
sels of  the  skin  catenated  with  the  pain  of  fear,  as  explained  iiT 
Sect.  XVI.  8.  1. 

The  capillaries  of  the  skin  consent  more  generally  by  direct 
sympathy  with  those  of  the  lower  intestines,  and  of  the  bladder; 
but  by  reverse  sympathy  more  generally  with  those  of  the  stomach 
and  upper  intestines.  As  appears  in  fevers,  where  the  hot  skin 
accompanies  indigestion  of  the  stomach;  and  in  diarrhoeas  at- 
tended with  cold  extremities. 

The  remote  cause  is  the  torpor  of  the  skin,  owing  to  its  reverse 
sympathy  with  the  painful  sensual  motions,  or  ideas  of  fear; 
which  are  now  actuated  with  great  energy,  so  as  to  deprive  the 
second  link  of  associated  motions  of  their  due  share  of  sensorial 
power.  It  is  also  probable  that  the  pain  of  fear  itself,  may  con- 
tribute to  exhaust  the  sensorial  power,  even  when  it  produces  no 
muscular  action.  See  Class  IV.  2.  2. 

5.  Pallor  et  tremor  a timore.  A retrograde  action  of  the  ca- 
pillaries of  the  skin  producing  paleness,  and  a torpor  of  the  mus- 
cular fibres  of  the  limbs  occasioning  trembling,  are  caused  by 
their  reverse  associations  with  the  ideas  or  imaginations  of  fear; 
which  are  now  actuated  with  violent  energy,  and  accompanied 
with  great  pain.  The  cause  of  these  associations  is  explained  in 
Sect.  XVI.  8.  1. 

These  torpid  actions  of  the  capillaries  and  muscles  of  the 
limbs  are  not  caused  immediately  by  the  painful  sensation  of 
fear;  as  in  that  case  they  would  have  been  increased  and  not 
decreased  actions,  as  occurs  in  anger;  where  the  painful  voli- 
tion increases  the  actions  of  the  capillaries,  exciting  a blush  and 
heat  of  the  skin.  AVhence  we  may  gain  some  knowledge  of 
what  is  meant  by  depressing  and  exciting  passions;  the  former 
consisting  of  ideas  attended  with  pain,  which  pain  occasions  no 
muscular  actions,  like  the  pain  of  cold  .head-ach;  the  latter  be- 
ing attended  with  volitions,  and  consequent  muscular  exertions. 
That  is,  the  pain  of  fear,  and  the  pain  of  anger,  are  produced 
by  the  exertions  of  certain  ideas,  or  motions  of  certain  nerves  or 
sense;  in  the  former  case  the  painful  sensation  of  fear  produces 
no  muscular  actions,  yet  it  exhausts  or  employs  so  much  sensorial 
power,  that  the  whole  system  acts  more  feebly,  or  becomes 
retrograde;  but  some  parts  of  it  more  so  than  others,  according 
to  their  early  associations  described  in  Sect.  XVI.  8.  1.  hence 
the  tremor  of  the  limbs,  palpitation  of  heart,  and  even  syncope 
In  anger  the  painful  volition  produces  violent  muscular  actions.: 


Class  IV.  3.  1.  6. 


OF  ASSOCIATION. 


437 


but  if  previous  to  these  any  deliberation  occurs,  a flushed  coun- 
tenance sometimes,  and  a red  skin,  are  produced  by  this  supera- 
bundance of  volition  exerted  on  the  arterial  system;  but  at  other 
times  the  skin  becomes  pale,  and  the  legs  tremble,  from  the 
exhaustion  or  expenditure  of  the  sensorial  power  by  the  painful 
volitions  of  anger  on  the  organs  of  sense,  as  by  the  painful  sen- 
sations of  fear  above  mentioned. 

Where  the  passion  of  fear  exists  in  a great  degree,  it  exhausts 
or  expends  so  much  sensorial  power,  either  simply  by  the  pain 
which  attends  it,  or  by  the  violent  and  perpetual  excitement  of 
the  terrific  imaginations,  or  ideas,  that  not  only  a cold  and  pale 
skin,  but  a retrograde  motion  of  the  cutaneous  absorbents  oc- 
curs, and  a cold  sweat  appears  upon  the  whole  surface  of  the 
body,  which  probably  sometimes  increases  pulmonary  absorp- 
tion; as  in  Class  II.  1.  6.  4.  and  as  in  the  cold  sweats,  which 
attend  the  paroxysms  of  humoral  asthma.  Hence  anxiety, 
which  is  a continued  pain  of  fear,  so  universally  debilitates  the 
constitution  as  to  occasion  a lingering  death;  which  happens 
much  more  frequently  than  is  usually  supposed;  and  these  vic- 
tims of  continued  anxiety  are  said  to  die  of  a broken  heart. 
Other  kiuds  of  paleness  are  described  in  Class  I.  2.  2.  2. 

M.  M.  Opium.  Wine.  Food.  Joy. 

6.  Palpilatio  cordis  a tirnore.  The  palpitation  of  the  heart 
from  fear  is  owing  to  the  wreak  action  of  it,  and  perhaps  some- 
times to  the  retrograde  exertion  of  the  ventricles  and  auricles; 
because  it  seems  to  be  affected  by  its  association  with  the  capil- 
laries, the  actions  of  which,  with  those  of  the  arteries  and  veins, 
constitute  one  great  circle  of  associate  motions.  Now  when 
the  capillaries  of  the  skin  become  torpid,  coldness  and  paleness 
succeed;  and  with  these  are  associated  the  capillaries  of  the 
lungs,  whence  difficult  respiration;  and  with  these  the  weak 
and  retrograde  actions  of  the  heart.  At  the  same  time  the  ab- 
sorbents of  the  skin,  and  of  the  bladder,  and  of  the  intestines, 
sometimes  become  retrograde,  and  regurgitate  their  contents; 
as  appears  by  the  pale  urine,  in  large  quantities,  which  attends 
hysteric  complaints  along  with  this  palpitation  of  the  heart; 
and  from  the  cold  sweats  and  diarrhoea;  all  which,  as  well  as 
the  hysteric  complaints,  are  liable  to  be  induced  or  attended  by 
fear. 

When  fear  has  still  more  violently  affected  the  system,  there 
have  been  instances  where  syncope,  and  sudden  death,  or  a total 
stoppage  of  the  circulation  have  succeeded;  in  these  last  cases, 
the  pain  of  fear  has  employed  or  exhausted  the  whole  of  the 
sensorial  power,  so  that  not  only  those  muscular  fibres  generally 
exerted  bv  volition  cease  to  act,  whence  the  patient  falls  down: 


438 


DISEASES 


Glass  IV.  3.  1.  7. 


and  those  which  constitute  the  organs  of  sense,  whence  syn- 
cope; but  lastly  those  which  perform  the  vital  motions,  become 
deprived  of  sensorial  power,  and  death  ensues.  See  Class  I.  2. 
1.  4.  and  I.  2.  1.  10.  Similar  to  this  in  some  epileptic  fits,  the 
patient  first  suddenly  falls  down,  without  even  endeavouring  to 
save  himself  by  his  hands,  before  the  convulsive  motions  come 
on.  In  this  case  the  great  exertion  of  some  small  part  in  con- 
sequence of  great  irritation  or  sensation  exhausts  the  whole  sen- 
sorial power,  which  was  lodged  in  the  extremities  of  the  lo- 
comotive nerves,  for  a short  time,  as  in  syncope;  and  as 
soon  as  these  muscles  are  again  supplied,  convulsions  supervene 
to  relieve  the  painful  sensation.  See  Class  III.  1.  1.  7. 

7.  Abortio  a timore.  Women  miscarry  much  more  frequent- 
ly from  a fright,  than  from  bodily  injury.  A torpor  or  retro- 
grade motion  of  the  capillary  arteries  of  the  internal  uterus  is 
probably  the  immediate  cause  of  these  miscarriages,  owiug  to 
the  association  of  the  actions  of  those  vessels  with  the  capillaries 
of  the  skin,  which  are  rendered  torpid  or  retrograde  by  fear. 
By  this  contraction  of  the  uterine  arteries,  the  fine  vessels  of  the 
placenta,  which  are  inserted  into  them,  are  detruded,  or  other- 
wise so  affected,  that  the  placenta  separates  at  this  time  from 
the  uterus,  and  the  fetus  dies  from  want  of  oxygenation. 
A strong  young  woman,  in  the  fifth  or  sixth  month  of  her  preg- 
nancy, who  has  since  borne  many  children,  went  into  her  cellar 
to  draw  beer;  one  of  her  servant-boys  was  hid  behind  a bar- 
rel, and  started  out  to  surprise  her,  believing  her  to  be  the 
maid-servant;  she  began  to  flood  immediately,  and  miscarried 
in  a few  hours.  See  Sect.  XXXIX.  6.  5.  and  Class  1.2.  1.  14. 

8.  Hysteria  a timore.  Some  delicate  ladies  are  liable  to  fall 
into  hysteric  fits  from  sudden  fright.  The  peristaltic  motions 
of  the  bowels  and  stomach,  and  those  of  the  oesophagus,  make 
a part  of  the  great  circle  of  irritative  motions  with  those  of  the 
skin  and  many  other  membranes.  Hence  when  the  cutaneous 
vessels  become  torpid  from  their  reverse  sympathy  with  the 
painful  ideas  of  fear;  those  of  the  bowels,  and  stomach,  and 
oesophagus,  become  first  torpid  by  direct  sympathy  with  those 
of  the  skin,  and  then  feebly  and  ineffectually  invert  the  order  of 
their  motions,  which  constitutes  a paroxysm  of  the  hysteric  dis- 
ease. See  Class  I.  3.  1.  10.  These  hysteric  paroxysms  are 
sometimes  followed  by  convulsions,  which  belong  to  Class  III. 
as  they  are  exertions  to  relieve  pain;  and  sometimes  by  death. 
See  Species  9.  of  this  Genus,  and  Class  I.  2.  1.  4. 

Indigestion  from  fear  is  to  be  ascribed  in  the  same  manner 
to  the  torpor  of  the  stomach,  owing  to  its  association  with  the 
skin.  As  in  Class  IV.  1.  2.  5.  IV.  2.  1. 


Class  IV.  3.  2.  1. 


OF  ASSOCIATION. 


439 


ORDO  III. 

Retrograde  Associate  Motions. 

GENUS  II. 

Catenated  with  Sensitive  Motions. 

SPECIES. 

1.  Nausea  idealis.  Nausea  from  disgustful  ideas,  as  from 
nauseous  stories,  or  disgustful  sights,  or  smells,  or  tastes,  as  well 
as  vomiting  from  the  same  causes,  consists  in  the  retrograde  ac- 
tions of  the  lymphatics  of  the  throat,  and  of  the  oesophagus,  and 
stomach;  which  are  associated  with  the  disgustful  ideas,  or  sen- 
sual motions  of  sight,  or  hearing,  or  smell,  or  taste;  for  as  these 
are  decreased  motions  of  the  lymphatics,  or  of  the  oesophagus,  or 
stomach,  they  cannot  immediately  be  excited  by  the  sensorial 
power  of  painful  sensation,  as  in  that  case  they  ought  to  be  in- 
creased motions.  So  much  sensorial  power  is  employed  for  a 
time  on  the  disgustful  idea,  or  expended  in  the  production  of 
inactive  pain,  which  attends  it,  that  the  other  parts  of  the  asso- 
ciated chain  of  action,  of  which  this  disgustful  idea  is  now  be- 
come a link,  are  deprived  of  their  accustomed  share;  and  there- 
fore first  stop  and  then  invert  their  motions.  Owing  to  defi- 
ciency of  sensorial  power,  as  explained  more  at  large  in  Sect. 
XXXY.  1.  3. 

2.  Nausea  a conceptu.  The  nausea,  which  pregnant  women 
are  so  subject  to  during  the  first  part  of  gestation,  is  owing  to  the 
reverse  sympathy  between  the  uterus  and  stomach,  so  that  the 

• increased  action  of  the  former,  excited  by  the  stimulus  of  the 
.growing  embryon,  which  I believe  is  sometimes  attended  with 
sensation,  produces  decreased  actions  of  the  latter  with  the  dis- 
agreeable sensation  of  sickness  with  indigestion  and  consequent 
acidity.  When  the  fetus  acquires  so  much  muscular  power  as 
to  move  its  limbs,  or  to  turn  itself,  which  is  called  quickening, 
this  sickness  of  pregnancy  generally  ceases. 

M.  M.  Calcined  magnesia.  Rhubarb.  Half  a grain  of 
opium  twice  a day.  Recumbent  posture  on  a sofa. 

3.  Vomitio  vertiginosa.  Sea-sickness,  the  irritative  motions  of 
vision,  by  which  we  balance  ourselves,  and  preserve  our  perpen- 
dicularity, are  disturbed  by  the  indistinctness  of  their  objects; 
which  is  either  owing  to  the  similarity  of  them,  or  to  their 


440 


DISEASES 


Glass  IV.  3 2.  4. 


distance,  or  to  their  apparent  or  unusual  motions.  Hence  these 
irritative  motions  of  vision  are  exeried  with  greater  energy,  and 
are  in  consequence  attended  with  sensation;  which  at  first  is 
agreeable,  as  when  children  swing  on  a rope;  afterwards  the 
irritative  motions  of  the  stomach,  and  of  the  absorbent  vessels, 
which  open  their  mouths  into  it,  become  inverted  by  their  asso- 
ciations with  them  by  reverse  sympathy. 

For  the  action  of  vomiting,  as  well  as  the  disagreeable  sen- 
sation of  sickness,  are  shown  to  be  occasioned  by  defect  of  the 
sensorial  power;  which  in  this  case  is  owing  to  the  greater  ex- 
penditure of  it  by  the  sense  of  vision.  On  the  same  account  the 
vomiting,  which  attends  the  passage  of  a stone  through  the 
ureter,  or  an  inflammation  of  the  bowels,  or  the  commencement 
of  some  fevers,  is  caused  by  the  increased  expenditure  of  the  sen- 
sorial power  by  the  too  great  action  of  some  links  of  the  associa- 
tions of  irritative  motions;  and  there  being  in  consequence  a 
deficiency  of  the  quantity  required  for  other  links  of  this  great 
catenation. 

It  must  be  observed,  that  the  expenditure  of  sensorial  power 
by  the  retinas  of  the  eyes  is  very  great;  w hich  may  be  estimated 
by  the  perpetual  use  of  those  organs  during  our  waking  hours, 
and  during  most  of  our  sleeping  ones;  and  by  the  large  diame- 
ters of  the  twm  optic  nerves,  which  are  nearly  the  size  of  a 
quill,  or  equal  to  some  of  the  principal  nerves,  which  serve  the 
limbs. 

4.  Vomitio  a calculo  in  uretere.  The  action  of  vomiting  in  con- 
sequence of  the  increased  or  decreased  actions  of  the  ureter, 
when  a stone  lodges  in  it.  The  natural  actions  of  the  stomach, 
which  consist  of  motions  subject  to  intermitted  irritations  from 
the  fluids,  which  puss  through  it,  are  associated  with  those  of  the 
ureter,  and  become  torpid,  and  consequently  retrograde,  by  in- 
tervals, when  the  actions  of  the  ureter  become  torpid  owing  to 
previous  great  stimulus  from  the  stone  it  contains;  as  appears  from 
the  vomiting  existing  when  the  pain  is  least.  When  the  motions  of 
the  ureter  are  thus  lessened,  the  sensorial  power  of  association, 
which  ought  to  actuate  the  stomach  along  with  the  sensorial 
power  of  irritation,  ceases  to  be  excited  into  action;  and  in  con- 
sequence the  actions  of  the  stomach  become  less  energetic,  and 
in  consequence  retrograde. 

For  as  vomiting  is  a decreased  action  of  the  stomach,  as  ex- 
plained in  Section  XXXV.  1.  3.  it  cannot  be  supposed  to  be  pro- 
duced by  the  pain  of  gravel  in  the  ureter  alone,  as  it  should  then 
be  an  increased  action,  not  a decreased  one. 

The  perpetual  vomiting  in  ileus  is  caused  in  like  manner  by 
the  defective  excitement  of  the  sensorial  powTer  of  association  by 


Class  IV.  3.  2.  5. 


OP  ASSOCIATION. 


441 


the  bowel,  which  is  torpid  during  the  intervals  of  pain;  and  the 
stomach  sympathizes  with  it.  See  Enteritis,  Class  II.  1.2.  11. 
Does  this  symptom  of  vomiting  indicate,  whether  the  disease  be 
above  or  below  the  valve  of  the  colon?  Does  not  the  softer  pulse 
in  some  kinds  of  enteritis  depend  on  the  sympathy  of  the  heart 
and  arteries  with  the  sickness  of  the  stomach?  See  Ileus  and 
Cholera. 

Hence  this  sickness,  as  well  as  the  sickness  in  some  fevers, 
cannot  be  esteemed  an  effort  of  nature  to  dislodge  any  offensive 
material;  but,  like  the  sea-sickness  described  above,  and  in  Sect. 
XX.  4.  is  the  consequence  of  the  associations  of  irritative  or  sen- 
sitive motions.  See  Class  I.  1.3.  9. 

5.  Vomitio  ab  insultu  paralytico.  Paralytic  affections  generally 
commence  with  vomiting;  the  same  frequently  happens  from  a 
violent  blow  with  a stick  on  the  head;  this  curious  connexion 
of  the  brain  and  stomach  has  not  been  explained;  as  it  resem- 
bles the  sickness  in  consequence  of  vertigo  at  sea,  it  would  seem 
to  arise  from  a similar  cause,  viz.  from  disturbed  irritative  or 
sensitive  associations. 

6.  Vomitio  a titillatione  faucium.  If  the  throat  be  slightly 

tickled  with  a feather,  a nausea  is  produced,  that  is,  an  inverted 
action  of  the  mouths  of  the  lymphatics  of  the  fauces,  and  by 
direct  sympathy  an  inverted  action  of  the  stomach  ensues.  As 
these  parts  have  frequently  been  stimulated  at  the  same  time  in- 
to pleasurable  action  by  the  deglutition  of  our  daily  aliment, 
their  actions  become  strongly  associated.  And  as  all  the  food 
we  swallow  is  either  moist  originally,  or  mixed  with  our  moist 
saliva  in  the  mouth;  a feather,  which  is  originally  dry,  and 
which  in  some  measure  repels  the  moist  saliva,  is  disagreeable  to 
the  touch  of  the  fauces;  at  the  same  time  this  nausea  and  vomit- 
ing cannot  be  caused  by  disagreeable  sensation  simply,  as  then 
they  ought  to  have  been  increased  exertions,  and  not  decreased 
ones,  as  shewn  in  Section  XXXV.  1 . 3.  But  the  mouths  of  the 
lymphatics  of  the  fauces  are  stimulated  by  the  dry  feather  into 
too  great  action  for  a time,  and  become  retrograde  afterwards  by 
the  debility  consequent  to  too  great  previous  stimulus. 

7.  Vomitio  cute  sympathetica.  Vomiting  is  successfully  stopped 
by  the  application  of  a blister  on  the  back  in  some  fevers,  where 
the  extremities  are  cold  and  the  skin  pale.  It  was  stopped  by 
Sydenham  by  producing  a sweat  on  the  skin  by  covering  the 
bead  with  the  bedclothes.  See  Class  IV.  1.  1.  3.  and  Suppl. 
I.  11.  6. 


3 L 


VOI..  IT. 


442 


DISEASES 


Class  IV.  3.  o.  1 


ORDO  III. 

Retrograde  Associate  Motions. 

GENUS  III. 

Catenated  with  Voluntary  Motions. 

SPECIES. 

1.  Ruminatio.  In  the  rumination  of  horned  cattle  the  food  is 
brought  up  from  the  first  stomach  by  the  retrograde  motions  of 
the  stogaach  and  oesophagus,  which  are  catenated  with  the  volun- 
tary motions  of  the  abdominal  muscles. 

2.  Vomitio  voluntaria.  Voluntary  vomiting.  Some  human 
subjects  have  been  said  to  have  obtained  this  power  of  voluntary 
action  over  the  retrograde  motions  of  the  stomach  and  oesophagus, 
and  thus  to  have  been  able  to  empty  their  stomach  at  pleasure.  See 
Sect.  XXV.  6.  This  voluntary  act  of  emptying  the  stomach  is 
possessed  by  some  birds,  as  the  pigeon;  who  has  an  organ  for  se- 
creting milk  in  its  stomach,  as  Mr.  Hunter  observed;  and  softens 
the  food  for  its  young  by  previously  swallowing  it;  and  after- 
wards putting  its  bill  into  theirs,  returns  it  into  their  mouths.  See 
Sect.  XXXIX.  4.  8.  The  pelicans  use  a stomach,  or  throat-bag, 
for  the  purpose  of  bringing  the  fish,  which  they  catch  in  the  sea, 
to  shore,  and  then  eject  them,  and  eat  them  at  their  leisure.  See 
Sect.  XVI.  11.  And  I am  well  informed  of  a bitch,  who  having 
puppies  in  a stable  at  a distance  from  the  house,  swallowed  the 
tlesh-meat,  which  was  given  her,  in  large  pieces,  and  carrying  it 
immediately  to  her  wdielps,  brought  it  up  out  of  her  stomach,  and 
laid  it  down  before  them. 

3.  Eructatio  voluntaria.  Voluntary  eructation.  Some,  who 
have  iveak  digestions,  and  thence  have  frequently  been  induced 
to  eruct  the  quantity  of  air  discharged  from  the  fermenting  ali- 
ment in  their  stomachs,  have  gradually  obtained  a power  of  volun- 
tary eructation,  and  have  been  able  thus  to  bring  up  hogsheads  of 
air  from  their  stomachs  whenever  they  pleased.  This  great 
quantity  of  air  is  to  be  ascribed  to  the  increase  of  the  fermenta- 
tion of  the  aliment  by  drawing  off  the  gas  as  soon  as  it  is  produced. 
See  Sect.  XXIII.  4. 


Cuss  IV.  3.  4. 1. 


OF  ASSOCIATION. 


443 


ORDO  in. 

Retrograde  Associate  Motions. 

GENUS  IV. 

Catenated  with  External  Influences. 

SPECIES. 

1.  Catarrlius  periodicus.  Periodical  catarrh  is  not  a very  un- 
common disease:  there  is  a great  discharge  of  a thin  saline  mu- 
cous material  from  the  membranes  of  the  nostrils,  and  probably 
from  the  maxillary  and  frontal  sinuses,  which  recur  once  a day 
at  exact  solar  periods;  unless  it  be  disturbed  by  exhibition  of 
opium;  and  resembles  the  periodic  cough  mentioned  below.  See 
Class  I.  3.  2.  1.  It  is  probably  owing  to  the  retrograde  action  of 
the  lymphatics  of  the  membranes  affected,  and  produced  imme- 
diately by  solar  influence. 

2.  Tussis  periodica.  Periodic  cough,  called  nervous  cough, 
and  tussis  ferina.  It  seems  to  arise  from  a periodic  retrograde 
action  of  the  lymphatics  of  the  membrane,  which  lines  the  air- 
cells  of  the  lungs.  And  the  action  of  coughing,  which  is  violent 
for  an  hour  or  longer,  is  probably  excited  by  the  stimulus  of  the 
thin  fluid  thus  produced,  as  well  as  by  the  disagreeable  sen- 
sation attending  membranous  inactivity;  and  resembles  periodic 
catarrh  not  only  in  its  situation  on  a mucous  membrane,  but  in 
the  discharge  of  a thin  fluid.  As  it  is  partly  restrainable,  it  does 
not  come  under  the  name  of  convulsion;  and  as  it  is  not  attended 
with  difficult  respiration,  it  cannot  be  called  asthma;  it  is  cured 
by  very  large  doses  of  opium ; see  a case  and  cure  in  Sect.  XXXVI. 

3.  9.  See  Class  IV.  2.  4.  6.  and  seems  immediately  to  be  induc- 
ed by  solar  influence. 

3.  Hysteria  a frigore.  Hysteric  paroxysms  are  occasioned  by 
whatever  suddenly  debilitates  the  system,  as  fear,  or  cold,  and 
perhaps  sometimes  by  external  moisture  of  the  air,  as  all  delicate 
people  have  their  days  of  greater  or  less  debility.  See  Class  IV. 
3.  1.  8. 

4.  Nausea  pluvialis.  Sickness  at  the  commencement  of  a 
rainy  season  is  very  common  among  dogs,  who  assist  themselves 
by  eating  the  agrostis  canina,  or  dog’s  grass,  and  thus  empty 
their  stomachs.  The  same  occurs  with  less  frequency  to  cats, 
who  make  use  of  the  same  expedient.  See  Sect.  XVI.  11.  - I 
have  known  one  person,  who  from  his  early  years  has  always 


444 


DISEASES,  &c. 


Ci, ass  IV.  3.4.4: 


been  sick  at  the  beginning  of  wet  weather,  and  still  continues 
so.  Is  this  owing  to  a sympathy  of  the  mucous  membrane  of 
the  stomach  with  the  mechanical  relaxation  of  the  external  cuti- 
cle by  a moister  atmosphere,  as  is  seen  in  the  corrugated  cuticle 
of  the  hands  of  washer- women?  or  does  it  sympathize  with  the 
mucous  membrane  of  the  lungs,  which  must  be  affected  along 
with  the  mucus  on  its  surface  by  the  respiratipn  of  a moister 
atmosphere? 


SUPPLEMENT 


TO 

CLASS  IV. 


Sympathetic  Theory  of  Fever. 

As  fever  consists  in  the  increase  or  diminution  of  direct  or  re- 
verse associated  motions,  whatever  may  have  been  the  remote 
cause  of  them,  it  properly  belongs  to  the  fourth  class  of  diseases; 
and  is  introduced  at  the  end  of  the  class,  that  its  great  difficulties 
might  receive  elucidation  from  the  preceding  parts  of  it.  These 
I shall  endeavour  to  enumerate  under  the  following  heads,  trust- 
ing that  the  candid  reader  will  discover  in  these  rudiments  of  the 
theory  of  fever  a nascent  embryon,  an  infant  Hercules,  which 
' time  may  rear  to  maturity,  and  render  serviceable  to  mankind, 

I.  Simple  fever  of  two  kinds. 

II.  Compound  fever. 

III.  Termination  of  the  cold  fit. 

IV.  Return  of  the  cold  fit. 

V.  Sensation  excited  in  fever. 

VI.  Circles  of  associated  motions. 

VII.  Alternations  of  cold  and  hot  fits. 

VIII.  Orgasm  of  the  capillaries. 

IX.  Torpor  of  the  lungs. 

X.  Torpor  of  the  brain. 

XI.  Torpor  of  the  heart  and  arteries. 

XII.  Torpor  of  the  stomach  and  intestines, 

XIII.  Case  of  continued  fever  explained. 

XIV.  Termination  of  continued  fever. 

XV.  Inflammation  excited  in  fever. 

XVI.  Recapitulation. 

I.  Simple  Fever. 

1.  When  a small  part  of  the  cutaneous  capillaries,  with  their 
mucous  or  perspirative  glands,  are  for  a short  time  exposed  to  a 
colder  medium,  as  when  the  hands  are  immersed  in  iced  water 


446 


THEORY  OF  FEVER. 


Scp.  I.  1.  2. 


for  a minute,  these  capillary  vessels  and  their  glands  become 
torpid  or  quiescent,  owing  to  the  eduction  of  the  stimulus  of  heat. 
The  skin  then  becomes  pale,  because  no  blood  passes  through  the 
external  capillaries;  and  appears  shrunk,  because  their  sides  are 
collapsed  from  inactivity,  not  contracted  by  spasm ; the  roots  of 
the  hair  are  left  prominent  from  the  seceding  or  subsiding  of  the 
skin  around  them;  and  the  pain  of  coldness  is  produced. 

In  this  situation,  if  the  usual  degree  of  warmth  be  applied, 
these  vessels  regain  their  activity;  and  having  now  become  more 
irritable  from  an  accumulation  of  the  sensorial  power  of  irritation 
during  their  quiescence,  a greater  exertion  of  them  follows,  with 
an  increased  glow  of  the  skin,  and  another  kind  of  pain,  which 
is  called  the  hot-ach;  but  no  fever,  properly  so  called,  is  yet  pro- 
duced; as  this  effect  is  not  universal,  nor  permanent,  nor  recur- 
rent. 

2.  If  a greater  part  of  the  cutaneous  capillaries  with  their 
mucous  and  perspirative  glands  be  exposed  for  a longer  time  .to 
cold,  the  torpor  or  quiescence  becomes  extended  by  direct  sym- 
pathy to  the  heart  and  arteries;  which  is  known  by  the  weak- 
ness, and  consequent  frequency,  of  the  pulse  in  cold  fits  of  fever. 

This  requires  to  be  further  explained.  The  movements  of  the 
heart  and  arteries,  and  the  whole  of  the  circulatory  vessels,  are  in 
general  excited  into  action  by  the  two  sensorial  powers  of  irri- 
tation, and  of  association.  The  former  is  excited  by  stimulus, 
the  latter  by  the  previous  actions  of  a part  of  the  vital  circle  of 
motions.  In  the  above  situation,  the  capillaries  act  weakly  from 
defect  of  irritation,  which  is  caused  by  deficient  stimulus  of  heat; 
but  the  heart  and  arteries  act  weakly  from  defect  of  association, 
which  is  owing  to  the  weak  action  of  the  capillaries;  which  does 
not  now  excite  the  sensorial  power  of  association  into  actiou  with 
sufficient  energy. 

After  a time,  either  by  the  application  of  warmth,  or  by  the 
increase  of  their  irritability  owing  to  the  accumulation  of  the 
sensorial  power  of  irritation,  during  their  previous  quiescence, 
the  capillary  vessels  and  glands  act  with  greater  energy  than  na- 
tural; whence  the  red  colour  and  heat  of  the  skin.  The  heart 
and  arteries  acquire  a greater  strength  of  pulsation,  and  continue 
the  frequency  of  it,  owing  to  the  accumulation  of  the  sensorial 
powder  of  association  during  their  previous  torpor,  and  their  con- 
sequent greater  associability;  which  is  now  also  more  strongly 
excited  by  the  increased  actions  of  the  capillaries.  And  thus  a 
fit  of  simple  fever  is  produced,  which  is  termed  febris  irrita- 
tiva;  and  consists  of  a torpor  of  the  cutaneous  capillaries  with 
their  mucous  and  perspirable  glands,  accompanied  with  a torpor 


Sup.  I.  1. 3.  THEORY  OP  FEVER.  44t 

of  the  heart  and  arteries;  and  afterwards  of  an  increased  ac- 
tion of  all  these  vessels,  by  what  is  termed  direct  sympathy. 

This  fever,  with  strong  pulse,  without  inflammation,  or  febris 
irritativa,  described  in  Class  I.  1.  1.  1.  is  frequently  seen  in  ver- 
nal intermittents,  as  the  orgasm  of  the  heart  and  arteries  is  then 
occasioned  by  their  previous  slate  of  torpor;  but  more  rarely  I 
believe  exists  in  the  type  of  continued  fever,  except  there  be  an 
evident  remission,  or  approximation  to  a cold  fit;  at  which  time 
a new  accumulation  of  the  sensorial  power  of  association  is  pro- 
duced; which  afterwards  actuates  the  heart  and  arteries  with 
unnatural  vigour;  or  unless  there  be  some  stimulus  perpetually 
acting  on  the  system,  so  as  to  induce  an  increased  secretion  of 
sensorial  power  in  the  brain,  as  occurs  in  slight  degrees  of  intoxi- 
cation. Since  without  one  or  other  of  these  circumstances  in 
continued  fevers  without  inflammation,  that  is,  without  the  ad- 
ditional sensorial  power  of  sensation  being  introduced,  it  seems 
difficult  to  account  for  the  production  of  so  great  a quantity  of 
sensorial  pow'er,  as  must  be  necessary  to  give  perpetual  increase 
of  action  to  the  whole  sanguiferous  system. 

3.  On  the  contrary,  while  the  cutaneous  capillaries  with  their 
mucous  and  perspirative  glands  acquire  an  increased  irritability, 
as  above,  by  the  accumulation  of  that  sensorial  power  during 
their  previous  quiescence,  and  thus  constitute  the  hot  fit  of  fe- 
ver; if  the  heart  and  arteries  do  not  acquire  any  increase  of  asso- 
ciabilitv,  but  continue  in  their  state  of  torpor,  another  kind  of 
simple  fever  is  produced;  which  is  generally  of  the  continued 
kind,  and  is  termed  febris  inirritativa;  which  consists  of  a pre- 
vious torpor  of  (he  capillaries  of  the  skin,  and  of  the  heart  and 
arteries  by  direct  sympathy  with  them;  and  afterwards  of  an 
orgasm  or  increased  action  of  the  capillaries  of  the  skin,  with  a 
decreased  action,  or  continued  torpor,  of  the  heart  and  arteries 
by  reverse  sympathy  with  them.  This  orgasm  of  the  cutaneous 
capillaries,  which  appears  by  the  blush  and  heat  of  the  skin,  is 
at  first  owing  to  the  accumulation  of  the  sensorial  power  of  irri- 
tation during  their  previous  torpid  state,  as  in  the  febris  irritata 
above  described;  but  which  is  afterwards  supported  or  continued 
by  the  reverse  sympathy  of  these  capillaries  with  the  torpid  state 
of  the  heart  and  arteries,  as  will  be  further  explained  in  article 
8.  of  this  Supplement. 

4.  The  renovated  activity  of  the  capillaries  commences  as 
soon  or  sooner  than  that  of  the  heart  and  arteries  after  the  cold 
fit  of  irritative  fever;  and  is  not  owing  to  their  being  forced 
open  by  the  blood  being  impelled  into  them  mechanically,  by 
the  renovated  action  of  the  heart  and  arteries;  for  these  capil- 
laries of  the  skin  have  greater  mobility  than  the  heart  and  arte- 


448 


THEORY  OF  FEVER. 


Sup.  1. 1.  5. 


vies,  as  appears  in  the  sudden  blush  of  shame;  which  may  be 
owing  to  their  being  more  liable  to  perpetual  varieties  of  activity 
from  their  exposure  to  the  vicissitudes  of  atmospheric  heat.  And 
because  in  inirritative  fevers,  or  those  with  arterial  debility,  the 
capillaries  acquire  increased  strength,  as  is  evinced  by  the  heat 
of  the  skin,  while  the  pulsations  of  the  heart  and  arteries  remain 
feeble. 

5.  It  was  said  above,  that  the  cutaneous  capillaries,  when 
they  were  rendered  torpid  by  exposure  to  cold,  either  recovered 
their  activity  by  the  reapplication  of  external  warmth;  or  by 
their  increased  irritability,  which  is  caused  by  the  accumula- 
tion of  that  sensorial  power  during  their  quiescence.  An  ex- 
ample of  the  former  of  these  may  be  seen  on  emerging  from  a 
very  cold  bath;  which  produces  a fit  of  simple  fever;  the  cold 
fit,  and  consequent  hot  fit,  of  which  may  be  prolonged  by  con- 
tinuing in  the  bath;  which  has  indeed  proved  fatal  to  some  weak 
and  delicate  people,  and  to  others  after  having  been  much  ex- 
hausted by  heat  and  exercise.  See  Sect.  XXXII.  3.  2.  An 
example  of  the  latter  may  be  taken  from  going  into  a bath  of 
about  eighty  degrees  of  heat,  as  into  the  bath  at  Buxton,  where 
the  bather  first  feels  a chill,  and  after  a minute  becomes  warm, 
though  he  remains  in  the  same  medium,  owing  to  the  increase 
of  irritability  from  the  accumulation  of  that  sensorial  power  dur- 
ing the  short  time  which  the  chilness  continued. 

6.  Hence  simple  fevers  are  of  two  kinds;  first,  the  febris 
irritativa,  or  fever  with  strong  pulse,  which  consists  of  a previous 
torpor  of  the  heart,  arteries,  and  capillaries,  and  a succeeding 
orgasm  of  those  vessels.  Secondly,  the  febris  inirritativa,  or  fe- 
ver with  weak  pulse,  which  consists  of  a previous  torpor  of  the 
heart,  arteries,  and  capillaries;  and  of  a succeeding  orgasm  of 
the  capillaries,  the  torpor  of  the  heart  and  arteries  continuing. 
But  as  the  frequency  of  the  pulse  occurs  both  in  the  state  of  tor- 
por, and  in  that  of  orgasm,  of  the  heart  and  arteries;  this  consti- 
tutes a criterion  to  distinguish  fever  from  other  diseases,  which 
are  owing  to  the  torpor  of  some  parts  of  the  system,  as  paresis, 
and  hemicrania. 

7.  The  reader  will  please  to  observe,  that  where  the  cutane- 
ous or  pulmonary  capillaries  are  mentioned,  their  mucous  and 
perspirative  glands  are  to  be  understood  as  included;  but  that 
the  absorbents  belonging  to  those  systems  of  vessels,  and  the 
commencement  of  the  veins,  are  not  always  included;  as  these 
are  liable  to  torpor  separately,  as  in  anasarca,  and  petechias;  or 
to  orgasm,  or  increased  action,  as  in  the  exhibition  of  strong 
emetics,  or  in  the  application  of  vinegar  to  the  lips;  yet  he  will 
also  please  to  observe,  that  an  increased  or  decreased  action  of 


Scp.  I.  2.  1, 


THEORY  OF  FEVER. 


449 


these  absorbents  and  veins  generally  occurs  along  with  that  of 
the  capillaries,  as  appears  by  the  dry  skin  in  hot  fits  of  fever; 
and  from  there  being  generally  at  the  same  time  no  accumula- 
tion of  venous  blood  in  the  cutaneous  vessels,  which  would  ap» 
pear  by  its  purple  colour. 

II.  Compound,  Fever. 

1.  When  other  parts  of  the  system  sympathize  with  this  tor- 
por and  orgasm  of  the  cutaneous  capillaries,  and  of  the  heart 
and  arteries;  the  fever-fit  becomes  more  complicated  and  dan- 
gerous; and  this  in  proportion  to  the  number  and  consequence 
of  such  affected  parts.  Thus  if  the  lungs  become  affected,  as 
in  going  into  very  cold  water,  a shortness  of  breath  occurs; 
which  is  owing  to  the  collapse  or  inactivity  (not  to  the  active 
contraction  or  spasm)  of  the  pulmonary  capillaries;  which,  aa 
the  lungs  are  not  sensible  to  cold,  are  not  subject  to  painful 
sensation,  and  consequent  shuddering,  like  the  skin.  In  this  case 
after  a time  the  pulmonary  capillaries,  like  the  cutaneous  ones, 
act  with  increased  energy;  the  breathing,  which  was  before 
quick,  and  the  air  thrown  out  at  each  respiration  in  less  quan- 
tity, and  cool  to  the  back  of  the  hand  opposed  to  it,  now  becomes 
larger  in  quantity,  and  warmer  than  natural;  which  however 
is  not  accompanied  with  the  sensation  of  heat  in  the  membrane, 
which  lines  the  air-vessels  of  the  lungs,  as  in  the  skin. 

2.  One  consequence  of  this  increased  heat  of  the  breath  is 
the  increased  evaporation  of  the  mucus  on  the  tongue  and  nos- 
trils. A viscid  material  is  secreted  by  these  membranes  to  pre- 
serve them  moist  and  supple,  for  the  purposes  of  the  senses  of 
taste  and  of  smell,  which  are  extended  beneath  their  surfaces; 
this  viscid  mucus,  when  the  aqueous  part  of  it  is  evaporated  by 
the  increased  heat  of  the  respired  air,  or  is  absorbed  by  the  too 
great  action  of  the  mucous  absorbents,  adheres  closely  on  those 
membranes,  and  is  not  without  difficulty  to  be  separated  from 
them.  This  dryness  of  the  tongue  and  nostrils  is  a circumstance 
therefore  worthy  to  be  attended  to;  as  it  shews  the  increased 
action  of  the  pulmonary  capillaries,  and  the  consequent  increas- 
ed heat  of  the  expired  air;  and  may  thus  indicate,  when  colder 
air  should  be  admitted  to  the  patient.  See  Class  I.  1.  3.  1. 
The  middle  part  of  the  tongue  becomes  dry  sooner,  and  recovers 
its  moisture  later,  than  the  edges  of  it;  because  the  currents 
of  respired  air  pass  most  over  the  middle  part  of  it.  This  how- 
ever is  not  the  case,  when  the  dryness  of  the  tongue  is  owing 
only  to  the  increased  mucous  absorption.  When,  however,  a 
frequent  cough  attends  pulmonary  inflammation,  the  edges  of 

von  xi.  3 M 


THEORY  OF  FEVER. 


Sup.  1.  2.  j. 


450 

the  tongue  are  liable  to  be  as  much  furred  as  the  middle  of  it; 
as  during  the  action  of  coughing  the  middle  of  the  tongue  is  de- 
pressed, so  as  to  form  half  a cylinder,  to  give  a greater  aper- 
ture for  the  emission  of  air  from  the  larynx,  and  the  edges  of 
it  become  thus  as  much  exposed  to  the  currents  of  air  as  the 
middle  parts  of  it. 

3.  When  the  internal  capillaries  or  glands  sympathize  with 
the  cutaneous  capillaries;  or  when  any  of  them  are  previously 
affected  with  torpor,  and  the  external  or  cutaneous  capillaries 
are  affected  secondarily;  other  symptoms  are  produced,  which 
render  the  paroxysms  of  fever  still  more  complicate.  Thus  if  the 
spleen  or  pancreas  are  primarily  or  secondarily  affected,  so  as  to 
be  rendered  torpid  or  quiescent,  they  are  liable  to  become  en- 
larged, and  to  remain  so  even  after  the  extinction  of  the  fever- 
fit.  These  in  some  intermittent  fevers  are  perceptible  to  the 
hand,  and  are  called  ague-cakes;  their  tumour  seems  to  be  ow- 
ing to  the  permanent  torpor  of  the  absorbent  system,  the  secern- 
ing vessels  continuing  to  act  some  time  afterwards.  If  the  se- 
cretory vessels  of  the  liver  are  affected  first  with  torpor,  and  af- 
terwards with  orgasm,  a greater  secretion  of  bile  is  produced, 
which  sometimes  causes  a diarrhoea.  If  a torpor  of  the  kidneys, 
and  of  the  absorbents  of  the  bladder  occurs,  either  primarily,  or 
by  sympathy  with  the  cutaneous  capillaries,  the  urine  is  in  small 
quantity  and  pale,  as  explained  in  Class  I.  2.  2.  5 .;  and  if  these 
secretory  vessels  of  the  kidneys,  and  the  absorbents  of  the  blad- 
der act  more  strongly  than  natural  afterwards  by  their  increased 
irritability  or  associability,  the  urine  becomes  in  larger  quantity, 
and  deeper  coloured,  or  deposites  its  earthy  parts,  as  in  Class  I.  1 . 
2.  4.  which  has  been  esteemed  a favourable  circumstance.  But 
if  the  urine  be  in  small  quantity,  and  no  sediment  appears  in  it, 
after  the  hot  fit  is  over;  it  shews  that  the  secerning  vessels  of 
the  kidneys  and  the  absorbent  vessels  of  the  bladder  have  not 
regained  the  whole  of  their  activity,  and  thence  indicates  a 
greater  tendency  to  a return  of  the  cold  fit. 

4.  When  the  stomach  is  affected  with  torpor  either  primarily: 
or  secondarily  by  its  sympathy  with  the  cutaneous  capilla- 
ries; or  with  some  internal  viscus;  sickness  occurs,  with  a total 
want  of  appetite  to  any  thing  solid;  vomiting  then  supervenes, 
which  may  often  be  relieved  by  a blister  on  the  skin,  if  the  skin 
be  cool  and  pale;  but  not  if  it  be  hot  and  flushed.  The  intes- 
tines cease  to  perform  their  office  of  absorption  from  a similar 
torpor;  and  a diarrhoea  supervenes  owing  to  the  acrimony  of 
their  putrid,  or  of  their  acid  contents.  The  loose  undigested  or 
fetid  stools  indicate  the  inability  of  the  intestines  to  perform 
their  proper  office;  as  the  mucus  and  gastric  acid,  which  are 


Sw.  I.  2.  5. 


THEORY  OF  FEVER. 


451 


vomited  up,  do  that  of  the  stomach;  this  torpor  of  the  stomach 
is  liable  to  continue  after  the  cold  paroxysm  ceases,  and  to  con- 
vert intermittent  fevers  into  continued  ones  by  its  direct  sympa- 
thy with  the  heart  and  arteries.  See  article  10.  of  this  Supple- 
ment. 

5.  If  the  meninges  of  the  brain  sympathize  with  other  torpid 
parts,  or  are  primarily  affected,  delirium,  stupor,  and  perhaps, 
hydrocephalus  internus,  occur,  see  Class.  II.  1.  7.  1.  and  1.2.  5. 
10.;  and  sometimes  the  pulse  becomes  slow,  producing  paresis 
instead  of  fever.  But  if  the  membranes,  which  cover  the  mus- 
cles about  the  head,  or  of  the  pericranium,  become  torpid  by 
their  sympathy  with  other  torpid  parts,  or  are  primarily  affected, 
a head-ach  supervenes;  which,  however,  generally  ceases  with 
the  cold  paroxysm  of  fever.  For  as  when  the  sensorial  power 
of  volition  is  exhausted  by  labour,  a few  hours,  or  half  a solar 
day,  passed  in  sleep  recruits  the  system  by  accumulation  of  this 
sensorial  power;  so  when  the  sensorial  power  of  irritation  is  ex- 
hausted, one  or  two  solar  or  lunar  days  of  rest  or  quiescence  of 
the  affected  part  will  generally  restore  its  action  by  accumulation 
of  irritability,  and  consequent  increase  of  association,  as  in  he- 
micrania,  Class  IV.  2.  2.  8.  But  when  the  heart  and  arteries 
become  torpid,  either  primarily,  or  by  their  sympathy  with  the 
stomach,  this  accumulation  of  the  sensorial  power  of  irritation 
can  take  place  but  slowly;  as  to  rest  is  death!  This  explains  the 
cause  of  the  duration  of  fevers  with  weak  pulse,  which  continue 
a quarter,  or  half,  or  three  quarters  ora  whole  lunation,  or  still 
longer,  before  sufficient  accumulation  of  irritability  can  be  pro- 
duced to  restore  their  natural  strength  of  action. 

6.  If  the  absorbent  vessels,  which  are  spread  around  the  neck 
of  the  bladder,  become  torpid  by  their  direct  sympathy  with  the 
absorbents  of  the  skin  in  cold  fits  of  fever;  the  urine,  which  is 
poured  into  the  bladder  in  but  small  quantity  from  the  torpid 
kidneys,  has  nevertheless  none  of  its  aqueous  saline  part  reab- 
sorbed; and  this  saline  part  stimulates  the  bladder  to  empty  it- 
self frequently,  though  the  urine  is  in  small  quantity.  Which  is 
not  therefore  owing  to  any  supposed  spasm  of  the  bladder,  for 
the  action  of  it  in  excluding  the  urine  is  weak,  and  as  much  con- 
trollable by  the  will  as  in  ordinary  micturition. 

7.  If  the  beginnings  or  absorbent  mouths  of  the  venous  sys- 
tem remain  torpid,  petechias  or  vibices  are  produced  in  fevers, 
similar  to  those  which  are  seen  in  scurvy  without  fever.  If  the 
skin  was  frequently  moistened  for  an  hour,  and  at  the  same  time 
exposed  to  the  common  air,  or  to  oxygen  gas,  it  might  contri- 
bute to  turn  the  black  colour  of  these  points  of  extravasated 
blood  into  scarlet,  and  thus  by  increasing  its  stimulus  facilitate 


452 


THEORY  OF  FEVER. 


Srp.  I.  2.  8. 


its  reabsorption?  For  oxygen  gas  penetrates  moist  animal  mem- 
branes though  not  dry  ones,  as  in  the  lungs  during  respiration. 
See  Class  I.  2.  1.  17. 

8.  When  the  sensorial  power  of  sensation  is  introduced  into 
the  arterial  system,  other  kinds  of  compound  fevers  are  produc- 
ed, which  will  be  spoken  of  in  their  place. 

III.  Termination  of  the  cold  Fit. 

1.  If  all  the  parts,  which  were  affected  with  torpor,  regain 
their  irritability,  and  associability,  the  cold  paroxysm  of  fever 
ceases;  but  as  some  of  the  parts  affected  were  previously  accus- 
tomed to  incessant  action,  as  the  heart  and  arteries,  and  others 
only  to  intermitted  action,  as  the  stomach  and  intestines;  and 
as  those  which  are  subjected  during  health  to  perpetual  action, 
accumulate  sensorial  power  faster,  when  their  motions  are  im- 
peded, than  those  which  are  subjected  to  intermitted  action;  it 
happens,  that  some  of  the  parts,  which  were  affected  writh  torpor 
during  the  cold  fit,  recover  their  irritability  or  associability  sooner 
than  others,  and  more  perfectly,  or  acquire  a greater  quantity  of 
them  than  natural;  as  appears  by  the  partial  heat  and  flushings 
previous  to  the  general  hot  fit. 

Hence  if  all  the  parts,  which  were  previously  torpid,  regain 
their  due  degree  of  irritability,  or  of  associability,  the  disease  is 
removed,  and  health  restored.  If  some  or  all  of  them  acquire 
more  than  their  natural  degree  of  these  sensorial  powers;  in- 
creased actions,  and  consequent  increased  secretions,  and  greater 
heat  occur,  and  constitute  the  hot  fit  of  fever.  If  after  this  hot 
fit  of  fever  all  the  parts  which  had  acquired  too  great  irritability 
or  associability,  regain  their  natural  degree  of  it,  the  disease  is 
removed,  and  health  restored.  But  if  some  of  these  parts  do 
not  regain  their  natural  degree  of  these  sensorial  powers,  the 
actions  of  those  parts  remain  imperfect,  and  are  more  or  less 
injurious  to  the  system  according  to  the  importance  of  their  func- 
tions. 

2.  Thus  if  a torpor  of  the  heart  and  arteries  remains;  the 
quick  pulse  without  strength,  which  began  in  the  cold  fit,  per- 
sists; and  a continued  fever  is  produced.  If  the  torpor  of  the 
stomach  and  intestines  remains,  which  is  known  by  sickness  and 
undigested  stools,  the  fever  is  liable  to  be  of  considerable  length 
and  danger;  the  same  if  the  kidneys  and  absorbent  system  re- 
tain some  degree  of  torpor,  as  is  shewn  by  the  pale  urine  in  not 
unusual  quantity.  If  part  of  the  absorbent  system  remains  tor- 
pid, as  the  absorbent  vessels  of  the  spleen,  a tumour  of  that  vis- 
cus  occurs,  which  may  be  felt  by  the  hand;  the  same  some- 


Sup  I.  3. 3. 


THEORY  OF  FEVER. 


453 


times  happens  to  the  liver;  and  these  from  their  tendency  to 
more  complete  torpor  are  afterwards  liable  to  give  occasion  to  a 
return  of  the  cold  fit.  If  the  cellular  absorbents  do  not  com- 
pletely recover  their  activity,  a pale  and  bloated  countenance 
with  swelled  legs  marks  their  want  of  action. 

3.  As  the  termination  of  the  cold  fit  is  owing  to  the  accumu- 
lation of  the  sensorial  power  of  irritation  and  of  association  dur- 
ing the  previous  quiescence  of  the  system;  and  as  those  parts, 
which  are  in  perpetual  action  during  health,  are  more  subject 
to  this  accumulation  during  their  torpor,  or  quiescence;  one 
should  have  imagined,  that  the  heart  and  arteries  would  acquire 
this  accumulation  of  sensorial  power  sooner  or  in  greater  degree 
than  other  parts.  This  indeed  so  happens,  where  the  pulse  is 
previously  strong,  as  in  febris  irritativa;  or  where  another  sen- 
sorial power,  as  that  of  sensation,  is  exerted  on  the  arterial  sys- 
tem, as  in  inflammations.  The  heart  and  arteries  in  these  cases 
soon  recover  from  their  torpor,  and  are  exerted  with  great  vio- 
lence. 

Many  other  parts  of  the  system  subject  to  perpetual  motion 
in  health  may  rest  for  a time  without  much  inconvenience 
to  the  whole;  as  when  the  fingers  of  some  people  become  cold 
and  pale;  and  during  this  complete  rest  great  accumulation  of 
irritability  may  be  produced.  But  where  the  heart  and  arte- 
ries are  previously  feeble,  they  cannot  much  diminish  their 
actions,  and  certainly  cannot  rest  entirely,  for  that  would  be 
death;  and  therefore  in  this  case  their  accumulation  of  the  sen- 
sorial power  of  irritation  or  of  association  is  slowly  produced, 
and  a long  fever  supervenes  in  consequence;  or  sudden  death, 
as  frequently  happens,  terminates  the  cold  fit. 

Whence  it  appears,  that  in  fevers  with  weak  pulse,  if  the 
action  of  the  heart,  arteries,  and  capillaries  could  be  diminished, 
or  stopped  for  a short  time  without  occasioning  the  death  of  the 
patient,  as  happens  in  cold  bathing,  or  to  persons  apparently 
drowned,  that  a great  accumulation  of  the  sensorial  powers  of 
irritation  or  of  association  might  soon  be  produced,  and  the  pulse 
become  stronger,  and  consequently  slower,  and  the  fever  cease. 
Hence  cold  ablution  may  be  of  service  in  fevers  with  weak 
pulse,  by  preventing  the  expenditure  and  producing  accumula- 
tion of  the  sensorial  power  of  irritation  or  association.  Stupor 
may  be  useful  on  the  same  account.  Could  a centrifugal  swing 
be  serviceable  for  this  purpose,  either  by  placing  the  head  or  the 
feet  in  the  outward  part  of  the  circle,  as  described  in  Art.  15,  7. 
of  this  supplement? 


454 


THEORY  OF  FEVER. 


Scp.  I.  4. 1. 


IV.  Return  of  the  Cold  Fit. 

1.  If  the  increased  action  of  the  cutaneous  and  pulmonary 
capillaries,  and  of  the  heart  and  arteries,  in  febris  irritativa,  con- 
tinues long  and  with  violence,  a proportional  expenditure  or  ex- 
haustion of  sensorial  power  occurs;  which  by  its  tendency  to  in- 
duce torpor  of  some  part,  or  of  the  whole,  brings  on  a return  of 
the  cold  fit. 

2.  Another  cause  which  contributes  to  induce  torpor  of  the 
whole  system  by  the  sympathy  of  its  parts  with  each  other,  is 
the  remaining  torpor  of  some  viscus;  which  after  the  last  cold 
paroxysm  had  not  recovered  itself,  as  of  the  spleen,  liver,  kid- 
neys, or  of  the  stomach  and  intestines,  or  absorbent  vessels,  as 
above  mentioned. 

3.  Other  causes  are  the  deficiency  of  the  natural  stimuli,  as 
hunger,  thirst,  and  want  of  fresh  air.  Other  causes  are  great 
fatigue,  want  of  rest,  fear,  grief,  or  anxiety  of  mind.  And  lastly, 
the  influence  of  external  ethereal  fluids,  as  the  defect  of  exter- 
nal heat,  and  of  solar  or  lunar  gravitation.  Of  the  latter  the 
return  of  the  paroxysms  of  continued  fevers  about  six  o’clock  in 
the  evening,  when  the  solar  gravitation  is  the  least,  affords  an 
example  of  the  influence  of  it;  and  the  usual  periods  of  inter- 
mitlents,  whether  quotidian,  tertian,  or  quartan,  which  so  regu- 
larly obey  solar  or  lunar  days,  afford  instances  of  the  influence  of 
those  luminaries  on  these  kinds  of  fevers. 

4.  If  the  tendency  to  torpor  in  some  viscus  is  considerable, 
this  will  be  increased  at  the  time,  when  the  terrene  gravitation 
is  greatest,  as  explained  in  the  introduction  to  Class  IV.  2.  4. 
and  may  either  produce  a cold  paroxysm  of  quotidian  fever;  or 
it  may  not  yet  be  sufficient  in  quantity  for  that  purpose,  but  may 
nevertheless  become  greater,  and  continue  so  till  the  next  period 
of  the  greatest  terrene  gravitation,  and  may  then  either  produce 
a paroxysm  of  tertian  fever;  or  may  still  become  greater,  and 
continue  so  till  the  next  period  of  greatest  terrene  gravitation, 
and  then  produce  a paroxysm  of  quartan  ague.  And  lastly,  the 
periodical  times  of  these  paroxysms  may  exceed,  or  fall  short  of, 
the  time  of  greatest  diurnal  terrene  gravitation  according  to  the 
time  of  day,  or  period  of  the  moon,  in  which  the  first  fit  began; 
that  is,  whether  the  diurnal  terrene  gravitation  was  then  in  an 
increasing  or  decreasing  state. 

V.  Sensation  excited  in  Fever. 

1.  A curious  observation  is  related  by  Dr.  Fordyce  in  his 


Slip.  I.  5:  2. 


THEORY  OF  FEVER. 


455 


Tract  on  Simple  Fever,  page  168.  He  asserts,  that  those  people 
who  have  been  confined  some  time  in  a very  warm  atmosphere, 
as  of  120  or  130  degrees  of  heat,  do  not  feel  cold,  nor  are  sub- 
ject to  paleness  of  their  skins,  on  coming  into  a temperature  of 
30  or  40  degrees;  which  would  produce  great  paleness  and  pain- 
ful sensation  of  coldness  in  those,  who  had  been  some  time  con- 
fined in  an  atmosphere  of  only  86  or  90  degrees.  Analogous  to 
this,  an  observing  friend  of  mine  assured  me,  that  once  having 
sat  up  to  a very  late  hour  with  three  or  four  very  ingenious  and 
humorous  companions,  and  drunk  a considerable  quantity  of 
wine;  both  contrary  to  his  usual  habits  of  life;  and  being  ob- 
liged to  rise  early,  and  to  ride  a long  journey  on  the  next  day, 
he  expected  to  have  found  himself  weak  and  soon  fatigued;  but 
on  the  contrary  he  performed  his  journey  with  unusual  ease  and 
alacrity;  and  frequently  laughed,  as  he  rode,  at  the  wit  of  the 
preceding  evening.  In  both  these  cases  a degree  of  pain  or 
pleasure  actuated  the  system;  and  thus  a sensorial  power,  that 
of  sensation,  was  superadded  to  that  of  irritation,  or  volition. 
See  Sect.  XXXIV.  2.  6. 

2.  Similar  to  this,  when  the  energetic  exertions  of  some  parts 
of  the  system  in  the  hot  fit  of  fever  arise  to  a certain  excess,  a 
degree  of  sensation  is  produced;  as  of  heat  which  particularly 
increases  the  actions  of  the  cutaneous  vessels,  which  are  more 
liable  to  be  excited  by  this  stimulus.  When  this  additional  sen- 
sorial power  of  sensation  exists  to  a greater  degree,  the  pulse, 
which  was  before  full,  now  becomes  hard,  owing  to  the  inflam- 
mation of  the  vasa  vasorum,  or  coats  of  the  arteries.  In  these 
cases  whether  there  is  any  topical  inflammation  or  not,  the  fever 
ceases  to  intermit;  but  nevertheless  there  are  daily  remissions 
and  exacerbations  of  it;  which  recur  for  the  most  part  about  six 
in  the  evening,  when  the  solar  gravitation  is  the  least,  as  men- 
tioned in  Sect.  XXXVI.  3.  7. 

3.  Thus  the  introduction  of  another  sensorial  power,  that  of 
sensation,  converts  an  intermittent  fever  into  a continued  one.  If 
it  be  attended  with  strong  pulse,  it  is  termed  febris  sensitiva  irri- 
tata,  or  pyrexia,  or  inflammation;  if  with  a weak  pulse,  it  is  term- 
ed febris  sensitiva  inirritata,  or  typhus  gravior,  or  malignant 
fever.  The  seat  of  the  inflammation  is  in  the  glandular  or  capil- 
lary system,  as  it  consists  in  the  secretion  of  new  fluids,  or  new 
fibres,  which  form  new  vessels,  as  they  harden,  like  the  silk  of 
the  silk-worm.  See  Art.  15.  of  this  Supplement. 

VI.  Circles  of  Irritative  Associate  Motions. 

1 . There  are  some  associate  motions,  which  arc  perpetually 


456 


THEORY  OF  FEVER 


Sup.  I.  6.  2. 


proceeding  in  our  waking  hours,  and  are  catenated  by  their  first 
link,  or  in  some  subsequent  parts  of  the  chain,  with  the  stimuli 
or  the  influence  of  external  things;  which  we  shall  here  enu- 
merate, as  they  contribute  to  the  knowledge  of  fever.  Of  these 
are  the  irritative  ideas,  or  sensual  motions  of  the  organs  of  sense, 
and  the  muscular  motions  associated  with  them;  which,  when 
the  chain  is  disturbed  or  interrupted,  excite  the  sensorial  power 
of  sensation,  and  proceed  in  confusion.  Thus  if  the  irritative 
ideas  of  sight  are  disturbed,  the  parallactic  motions  of  objects, 
which  in  general  are  unperceived,  become  sensible  to  us;  and 
the  locomotive  muscles  associated  with  them,  which  ought  to 
preserve  the  body  erect,  stagger  from  this  decrease  or  interrup 
tion  of  the  sensorial  power  of  association;  and  vertigo  is  pro- 
duced. 

When  the  irritative  sensual  motions,  or  ideas,  belonging  to 
one  sense  are  increased  or  diminished,  the  irritative  sensual  mo- 
tions, or  ideas,  of  the  other  senses  are  liable  to  become  disturbed 
by  their  general  catenations;  whence  occur  noises  in  the  ears, 
bad  tastes  in  the  mouth,  bad  odours,  and  numbness  or  tingling 
of  the  limbs,  as  a greater  or  less  number  of  senses  are  affected. 
These  constitute  concomitant  circles  of  disturbed  irritative  ideas; 
or  make  a part  of  the  great  circle  of  irritative  ideas,  or  motions 
of  the  organs  of  sense;  and  when  thus  disturbed  occasion  many 
kinds  of  hallucinations  of  our  other  senses,  or  attend  on  the  ver- 
tigo of  vision. 

2.  Another  great  circle  of  irritative  associated  motions  con- 
sists of  those  of  the  alimentary  canal;  which  are  catenated  with 
stimuli  or  with  influences  external  to  the  system,  but  continue 
to  be  exerted  in  our  sleeping  as  well  as  in  our  waking  hours. 
When  these  associations  of  motion  are  disturbed  by  the  too  great 
or  too  small  stimulus  of  the  food  taken  into  the  stomach,  or  by 
the  too  great  excess  or  deprivation  of  heat,  or  by  indigestible 
substances,  or  by  torpor  or  orgasm  occasioned  by  their  associa- 
tion with  other  parts,  various  diseases  are  induced  under  the 
names  of  apepsia,  hypochondriasis,  hysteria,  diarrhoea,  cholera, 
ileus,  nephritis,  fever. 

3.  A third  circle  of  irritative  associate  motions  consists  of  those 
of  the  absorbent  system;  which  may  be  divided  into  two,  the 
lacteals,  and  the  lymphatics.  When  the  stomach  and  intestines 
are  recently  filled  with  food  and  fluid,  the  lacteal  system  is 
stimulated  into  great  action;  at  the  same  time  the  cellular,  cuta- 
neous, and  pulmonary  lymphatics  act  with  less  energy;  because 
less  fluid  is  then  wanted  from  those  branches,  and  because  more 
sensorial  power  is  expended  by  the  lacteal  branch.  On  this  ac- 
count these  two  systems  of  absorbents  are  liable  to  act  by  reverse 


St*.  I.  6.  4 


THEORY  OF  FEVER. 


457 


sympathy;  hence  pale  urine  is  made  after  a full  dinner,  as 
less  of  the  aqueous  part  of  it  is  imbibed  by  the  urinary  lym- 
phatics; and  hence  the  water  in  anasarca  of  the  lungs  and  limbs 
is  speedily  absorbed,  when  the  actions  of  the  lacteals  of  the  sto- 
mach or  intestines  are  weakened  or  inverted  by  the  exhibition 
of  those  drugs  which  produce  nausea,  or  by  violent  vomiting,  or 
violent  cathartics. 

Hence  in  diabetes  the  lacteal  system  acts  strongly,  at  the  same 
time  that  the  urinary  lymphatics  invert  their  motions,  and  trans- 
mit the  chyle  into  the  bladder;  and  in  diarrhoea  from  crapula,  or 
too  great  a quantity  of  food  and  fluid  taken  at  a time,  the  lacteals 
act  strongly,  and  absorb  chyle  or  fluids  from  the  stomach  and 
upper  intestines;  while  the  lymphatics  of  the  lower  intestines 
revert  their  motions,  and  transmit  this  over-repletion  into  the 
lower  intestines,  and  thus  produce  diarrhoea;  which  accounts  for 
the  speedy  operation  of  some  cathartic  drugs,  when  much  fluid  is 
taken  along  with  them. 

4.  Other  circles  of  irritative  associate  motions  of  great  impor- 
tance, are  those  of  the  secreting  system;  of  these  are  the  motions 
of  the  larger  congeries  of  glands,  which  form  the  liver,  spleen, 
pancreas,  gastric  glands,  kidneys,  salivary  glands,  and  many 
others;  some  of  which  act  by  direct,  and  others  by  reverse  sym- 
pathy, with  each  other.  Thus,  when  the  gastric  glands  act  most 
powerfully,  as  when  the  stomach  is  filled  with  food,  the  kidneys 
act  with  less  energy;  as  is  shewn  by  the  small  secretion  of  urine 
for  the  first  hour  or  two  after  dinner;  which  reverse  sympathy  is 
occasioned  by  the  greater  expenditure  of  sensorial  power  on  the 
gastric  glands,  and  to  the  newly  absorbed  fluids  not  yet  being 
sufficiently  animalized,  or  otherwise  prepared,  to  stimulate  the 
secretory  vessels  of  the  kidneys. 

But  those  very  extensive  glands,  which  secrete  the  perspirable 
matter  of  the  skin  and  lungs,  with  the  mucus,  which  lubricates 
all  the  internal  cells  and  cavities  of  the  body,  claim  our  particu- 
lar attention.  These  glands,  as  well  as  all  the  others,  proceed 
from  the  capillary  vessels  which  unite  the  arteries  with  the 
veins,  and  are  not  properly  a part  of  them;  the  mucous  and  per- 
spirative  glands,  which  arise  from  the  cutaneous  and  pulmonary 
capillaries,  are  associated  by  direct  sympathy;  as  appears  from 
immersion  in  the  cold  bath,  which  is  therefore  attended  with  a 
temporary  difficult  respiration;  while  those  from  the  capillaries 
of  the  stomach  and  heart  and  arteries,  are  more  generally  asso- 
ciated by  reverse  sympathy  with  those  of  the  cutaneous  capilla- 
ries, as  appears  in  fevers  with  weak  pulse  and  indigestion,  and 
at  the  same  time  with  hot  and  dry  skin. 

The  disturbed  actions  of  this  circle  of  the  associate  motions  of 

3 N 


\'0L.  IX. 


468 


lilEOIlY  OF  FEVER. 


Ser.  I.  6.  5. 


the  secerning  system,  when  the  sensorial  power  of'  sensation  is 
added  to  that  of  irritation,  frequently  produces  inflammation, 
which  consists  in  the  secretion  of  new  fluids  or  new  vessels. 
Nevertheless,  if  these  disturbed  actions  be  of  the  torpid  kind,  the 
pain,  which  attends  them,  is  seldom  productive  of  inflammation, 
as  in  hemicrania;  but  is  liable  to  excite  voluntary  actions,  and 
thus  to  expend  much  sensorial  power,  as  in  the  shuddering  in 
cold  tils  of  fever,  or  in  convulsions;  or  lastly,  the  pain  itself,  which 
attends  torpid  actions,  is  liable  to  expend  or  exhaust  much  senso- 
rial power,  without  producing  any  increased  actions;  whence 
the  low  pulse,  and  cold  extremities,  which  usually  attend  hemi- 
crania; and  hence  when  inert,  or  inactive  sensation  attends  one 
link  of  associated  actions,  the  succeeding  link  is  generally  ren- 
dered torpid,  as  a coldness  of  the  cheek  attends  tooth-ach. 

5.  A fifth  important  circle  of  irritative  motions  is  that  of  the 
sanguiferous  system,  in  which  the  capillary  vessels  are  to  be  in- 
cluded, which  unite  the  arterial  and  venous  systems,  both  pul- 
monary and  aortal.  The  disturbed  action  of  this  system  of  the 
heart  and  arteries,  and  capillaries,  constitutes  simple  fever;  to 
which  may  be  added,  that  the  secerning  and  absorbent  vessels 
appending  to  the  capillaries,  and  the  bibulous  mouths  of  the  veins, 
are,  in  some  measure,  at  the  same  time  generally  affected. 

6.  Now,  though  the  links  of  each  of  these  circles  of  irritative 
motions  are  more  strictly  associated  together,  yet  they  are  in 
greater  or  less  degree  associated  or  catenated  with  each  other  by 
direct  cr  reverse  sympathy.  Thus  the  sickness,  or  inverted  irri- 
tative motions  of  the  stomach,  are  associated  or  catenated  with 
the  disturbed  irritative  ideas,  or  sensual  motions,  in  vertigo;  as 
in  sea-sickness.  This  sickness  of  the  stomach  is  also  associated 
or  catenated  with  the  torpor  of  the  heart  and  arteries  by  direct 
sympathy,  and  with  the  capillaries  and  absorbents  by  reverse 
sympathy;  and  are  thus  all  of  them  liable  occasionally  to  be  dis- 
turbed, when  one  of  them  is  diseased;  and  constitute  the  great 
variety  of  the  kinds  or  symptoms  of  fevers. 

VII.  Alternation  of  the  cold  and  hot  Fils. 

1.  When  any  cause  occurs,  which  diminishes  to  a certain  de- 
gree the  supply  of  sensorial  power  in  respect  to  the  whole  sys- 
tem; as  suppose  a temporary  inexerlion  of  the  brain;  what 
happens?  First,  those  motions  are  exerted  with  less  energy, 
which  are  not  immediately  necessary  to  life,  as  the  locomotive 
muscles;  and  those  ideas,  which  are  generally  excited  by  voli- 
tion; at  the  same  time,  this  deficiency  of  voluntary  motion  is 


Sup.  I.  7.  2. 


THEORY  OF  FEVER. 


459 


different  from  that  which  occurs  in  sleep;  as  in  that  the  move- 
ments of  the  arterial  system  are  increased  in  energy  though  not 
in  frequency.  Next,  the  motions  of  the  alimentary  canal  be- 
come performed  with  less  energy,  or  cease  altogether;  and  a 
total  want  of  appetite  to  solid  food  occurs,  or  sickness  or  a diarr- 
hoea occasioned  by  the  indigested  aliment.  Then  the  absorbent 
vessels  cease  to  act  with  their  due  energy;  whence  thirst,  and 
pale  urine,  though  in  small  quantities.  Fourthly,  the  secerning 
vessels  become  affected  by  the  general  diminution  of  sensorial 
power;  whence  all  the  secreted  fluids  are  produced  in  less 
quantity.  And  lastly,  the  sanguiferous  canals  feel  the  general 
torpor;  the  pulsations  of  the  heart  and  arteries  become  feeble, 
and  consequently  quick;  and  the  capillaries  of  the  skin  become 
inactive,  acquire  less  blood  from  the  arteries,  and  are  conse- 
quently paler  and  shrunk. 

In  this  last  circumstance  of  the  torpor  of  tire  sanguiferous  sys- 
tem consists  inirritative  fever;  as  all  the  others  are  rather  acci- 
dental or  concomitant  symptoms,  and  not  essential  ones;  as  fewer 
or  more  of  them  may  be  present,  or  may  exist  with  a greater  or 
less  degree  of  inactivity. 

2.  Now  as  the  capillaries  of  the  skin  are  exposed  to  greater 
varieties  of  heat  and  cold,  than  the  heart  and  arteries,  they  are 
supposed  to  be  more  mobile,  that  is,  more  susceptible  of  torpor 
or  exertion,  or  to  inflammation,  by  external  stimuli  or  influences, 
than  the  other  parts  of  the  sanguiferous  system;  and  as  the  skin 
is  more  sensible  to  the  presence  of  heat,  than  the  internal  parts 
of  the  body,  the  commencement  of  the  cold  paroxysms  of  fever 
generally  either  first  exists  in,  or  is  first  perceived  by  the  cold- 
ness and  paleness  of  the  skin;  and  the  commencement  of  the  hot 
fits  by  the  heat  and  redness  of  it. 

3.  The  accumulation  of  sensorial  power  occurs  in  these  or- 
gans soonest,  and  in  greatest  quantity,  during  their  quiescence, 
which  were  most  perpetually  in  action  during  health;  hence 
those  parts  of  the  system  soonest  recover  from  torpor  in  inter- 
mittent fever,  and  soonest  fall  into  the  contrary  extreme  of  in- 
creased activity;  as  the  sanguiferous  system  of  the  heart  and  ar- 
teries and  capillaries.  But  of  these  the  capillaries  seem  first  to 
acquire  a renovation  of  their  action,  as  the  heat  of  the  skin  be- 
comes first  renewed,  as  well  as  increased  beyond  its  natural 
quantity,  and  this  in  some  parts  sooner  than  in  others;  which 
quantity  of  heat  is  however  not  to  be  estimated  simply  by  the 
rise  of  the  mercury  in  the  thermometer,  but  also  by  the  quantity 
carried  away  into  the  atmosphere,  or  diffused  amongst  other 
bodies  in  a given  time;  as  more  heat  passes  through  water, 
which  boils  vehemently,  than  when  it  boils  gently,  though  the 


460 


THEORY  OF  FEVER. 


Sup.  1.  7.  4. 


rise  of  the  thermometer  in  both  cases  continues  the  same.  This 
fact  may  be  known  by  boiling  an  egg  in  water,  the  white  of 
which  coagulates  in  much  less  time,  if  the  water  boils  vehement- 
ly, than  if  it  boils  moderately,  though  the  sensible  heat  of  the 
■water  is  the  same  in  both  cases. 

Another  cause  which  induces  the  cutaneous  capillaries  to  re- 
new their  actions  sooner  than  the  heart  and  arteries  after  immer- 
sion in  the  cold  bath,  is,  that  their  torpor  was  occasioned  by  de- 
fect of  irritation:  whereas  that  of  the  heart  and  arteries  was 
occasioned  by  defect  of  association;  which  defect  of  association 
was  owing  to  the  decreased  actions  of  the  capillaries,  and  is  now 
again  excited  by  their  renewed  action;  which  excitement  must 
therefore  be  subsequent  to  that  increased  action  of  the  capilla- 
ries; and  in  consequence  the  increased  action  of  the  heart  and 
arteries  at  the  commencement  of  the  hot  fit  of  some  fevers  is  sub- 
sequent to  the  increased  action  of  the  cutaneous  capillaries. 
There  is,  however,  in  this  case  an  accumulation  of  the  sensorial 
power  of  association  in  the  heart  and  arteries,  which  must  con- 
tribute to  increase  their  orgasm  in  the  hot  fit,  as  well  as  the  in- 
creased excitement  of  it  by  the  increased  action  of  the  capillaries. 

4.  Now  this  increased  action  of  the  system,  during  the  hot  fit, 
by  exhausting  the  sensorial  powers  of  irritation  and  associa- 
tion, contributes  to  induce  a renewal  of  the  cold  paroxysm;  as 
the  accumulation  of  those  sensorial  powers  in  the  cold  fit  pro- 
duces the  increased  actions  of  the  hot  fit;  which  two  states  of 
the  system  reciprocally  induce  each  other  by  a kind  of  libration, 
or  a plus  and  minus,  of  the  sensorial  powers  of  irritation  and 
association. 

If  the  exhaustion  of  sensorial  power  during  the  hot  fit  of  fever 
only  reduces  the  quantity  of  irritability  and  associability  to  its 
natural  standard,  the  fever  is  cured,  not  being  liable  to  return. 
If  the  quantity  of  these  sensorial  powers  be  reduced  only  so  much, 
as  not  to  produce  a second  cold  fit  during  the  present  quantity  of 
external  stimuli  or  influences;  yet  it  may  be  so  far  reduced,  that 
a very  small  subtraction  of  stimulus,  or  of  influence,  may  again 
induce  a cold  fit;  such  as  the  coldness  of  the  night-air;  or  the 
diminution  of  solar  or  lunar  gravitation,  as  in  intermittent 
fevers. 

5.  Another  cause  of  the  renovation  of  the  cold  fits  of  fever 
is  from  some  parts  of  the  system  not  having  completely  reco- 
vered from  the  former  cold  paroxysm;  as  happens  to  the  spleen 
liver,  or  other  internal  viscus;  which  sometimes  remains  tumid, 
and  either  occasions  a return  of  the  cold  fit  by  direct  sympathy 
with  other  parts  of  the  body,  or  by  its  own  want  of  action  causes 
a diminution  of  the  general  quantity  of  heat,  and  thus  facili- 


Sup.  I.  8.  1. 


THEORY  OF  FEVER. 


461 


tates  the  renovation  of  the  torpor  of  the  whole  system,  and  gives 
cause  to  intermittent  fevers  catenated  with  lunar  or  solar  influ- 
ence. 

VIII.  Orgasm  of  the  Capillaries. 

As  the  remaining  torpor  of  some  less  essential  part  of  the  sys- 
tem, as  of  the  spleen,  when  the  hot  fit  ceases,  produces  after 
one,  two,  or  three  days  a return  of  cold  fit  by  direct  sympathy 
with  the  cutaneous  capillaries,  when  joined  with  some  other 
cause  of  torpor,  as  the  defect  of  solar  or  lunar  influences,  or  the 
exposure  to  cold  or  hunger,  and  thus  gives  origin  to  intermit- 
tent fever;  so  the  remaining  torpor  of  some  more  essential  parts 
of  the  system,  as  of  the  stomach  and  intestines,  is  probably  the 
cause  of  the  immediate  recurrence  of  the  cold  paroxysm,  at  the 
time  the  hot  one  ceases,  by  their  direct  sympathy  with  the  cu- 
taneous capillaries,  without  the  assistance  of  any  other  cause  of 
torpor;  and  thus  produces  remittent  fever.  And  lastly,  the  re- 
maining torpor  of  some  still  more  essential  parts  of  the  system, 
as  the  heart  and  arteries,  after  the  hot  fit  ought  to  cease,  is  lia- 
ble by  reverse  sympathy  with  the  cutaneous  capillaries  to  con- 
tinue their  orgasm,  and  thus  to  render  a fever  continual,  which 
would  otherwise  remit  or  intermit. 

Many  difficulties  here  occur,  which  we  shall  endeavour  to 
throw  some  light  upon,  and  leave  to  future  investigation;  ob- 
serving only  that  difficulties  were  to  be  expected,  otherwise  fe- 
vers would  long  since  have  been  understood,  as  they  have  em- 
ployed the  unremitted  attention  of  the  physicians  of  all  ages  of 
the  world. 

1.  Why  do  the  same  parts  of  successive  trains  of  action  some- 
times affect  each  other  by  direct,  and  sometimes  by  reverse  sym- 
pathy?— 1st.  When  any  irritative  motion  ceases,  or  becomes 
torpid,  which  was  before  in  perpetual  action;  it  is  either  de- 
prived of  its  usual  stimulus,  and  thence  the  sensorial  power  of 
irritation  is  not  excited;  or  it  has  been  previously  too  much  sti- 
mulated, and  the  sensorial  power  has  been  thus  exhausted. 

In  the  former  case  an  accumulation  of  sensorial  power  soon 
occurs,  which  is  excitable  by  a renewal  of  the  stimulus;  as  when 
the  fingers,  which  have  been  immersed  some  time  in  snow,  are 
again  exposed  to  the  usual  warmth  of  a room.  Or,  secondly,  the 
sensorial  power  of  irritation  becomes  so  much  accumulated,  that 
the  motions,  which  were  torpid,  are  now  performed  by  less 
stimulus  than  natural;  as  appears  by  the  warmth,  which  soon 
occurs  after  the  first  chill  in  going  into  frosty  air,  or  into  the 
bath  at  Buxton,  which  is  about  eighty  degrees  of  heat.  Or, 


4G2 


THEORY  OF  FEVER. 


Sep.  I.  8. 


lastly,  this  accumulation  of  the  sensorial  power  of  irritation  so 
far  abounds,  that  it  increases  the  action  of  the  next  link  of  the 
associated  train  or  tribe  of  motions;  thus  on  exposing  the  skin 
to  cold  air,  as  in  walking  out  in  a frosty  morning,  the  actions 
of  the  stomach  are  increased,  and  digestion  strengthened. 

But  where  the  torpor  of  some  irritative  motion  is  owing  to 
the  previous  exhaustion  of  the  sensorial  power  of  irritation  by 
too  great  stimulus,  the  restoration  of  it  occurs  either  not  at  all, 
or  much  more  slowly  than  in  the  former  instances;  thus  after 
intoxication  the  stomach  is  very  slow  in  recovering  its  due  quan- 
tity of  the  sensorial  power  of  irritation,  and  never  shews  any  ac- 
cumulation of  it. 

2 When  an  associate  motion,  as  described  in  the  introduc- 
tion to  class  IV.  1.1.  acts  with  less  energy,  the  sensorial  power 
of  association  is  either  not  sufficiently  excited  by  the  preced- 
ing fibrous  motions;  or  it  has  been  expended  or  exhausted  by 
the  too  violent  actions  of  the  preceding  fibrous  motions.  In  the 
former  case  there  occurs  an  accumulation  of  the  sensorial  power 
of  association;  exactly,  as,  where  the  usual  stimulus  is  with- 
drawn, there  occurs  an  accumulation  of  the  sensorial  power  of 
irritation.  Thus  when  the  actions  of  the  capillaries  of  the  skin 
are  diminished  by  immersion  in  cold  water,  the  capillaries  of  the 
lungs  are  rendered  torpid  by  the  want  of  the  excitement  of  the 
sensorial  powrer  of  association,  ou'ing  to  the  lessened  actions  of  the 
previous  fibrous  motions,  namely,  of  those  of  the  skin.  Never- 
theless as  soon  as  the  capillaries  of  the  skin  regain  their  increased 
activity  by  the  accumulation  of  the  sensorial  powTer  of  irrita- 
tion, these  capillaries  of  the  lungs  act  with  greater  energy  also 
owing  to  their  accumulated  sensorial  pow'er  of  association.  These 
are  instances  of  direct  sympathy,  and  constitute  the  cold  and 
hot  paroxysms  of  intermittent  fever;  or  the  first  paroxysm  of  a 
continued  one. 

8.  When  the  first  link  of  a train  of  associated  motions,  which 
is  subject  to  perpetual  action,  becomes  a considerable  time  tor- 
pid for  w ant  of  being  excited  by  the  previous  exertions  of  the 
irritative  motions,  with  which  it  is  catenated;  the  sensorial 
power  of  association  becomes  accumulated  in  so  great  a degree 
as  to  affect  the  second  link  of  the  train  of  associated  motions, 
and  to  excite  it  into  stronger  action.  Thus  when  the  stomach 
is  rendered  torpid  by  contagious  matter  swallowed  into  it  mixed 
with  the  saliva,  the  heart  and  arteries  act  more  feebly;  because 
the  sensorial  power  of  association,  which  used  to  be  excited  by 
the  fibrous  motions  of  the  stomach,  is  not  now  excited;  and  in 
consequence  the  motions  of  the  heart  and  arteries  act  only  by 


THEORY  OF  FEVER. 


Sup.  I.  8.  4. 


463 


the  sensorial  power  of  irritation,  which  is  excited  by  the  stimu- 
lus of  the  blood. 

But  during  this  torpor  of  the  stomach,  and  less  action  of  the 
heart  and  arteries,  so  great  an  accumulation  of  the  sensorial  pow- 
ers of  irritation  and  of  association  occurs,  that  it  adds  to  ihe  ac- 
tion of  the  next  link  of  this  vital  circle  of  actions,  that  is,  to  that 
of  the  cutaneous  capillaries.  Whence  in  this  situation  the  tor- 
por of  the  stomach  occasions  a diminished  action  of  the  heart  and 
arteries  by  direct  sympathy,  and  may  be  said  to  occasion  an  in- 
creased one  of  the  cutaneous  capillaries  by  reverse  sympathy* 
which  constitute  continued  fever  with  w'eak  pulse. 

Nor  is  this  increased  action  of  the  capillaries  in  consequence 
of  the  decreased  action  of  the  heart  and  arteries,  as  in  fevers 
with  weak  pulse,  a single  fact  in  the  animal  economy;  though 
it  exists  in  this  case  in  the  greatest  degree  of  duration,  because 
the  heart  and  arteries  are  perpetually  in  greater  action  than  any 
other  part  of  the  system.  But  a similar  circumstance  occurs, 
when  the  stomach  is  rendered  inactive  by  defective  excitement 
of  the  sensorial  power  of  association,  as  in  sea-sickness,  or  in 
nephritis.  In  these  cases  the  sensorial  pow'er  of  association  be- 
comes much  accumulated  in  the  stomach,  and  seems  by  its  su- 
perabundance to  excite  the  absorbent  system,  which  is  so  nearly 
connected  with  it,  into  great  increase  of  action;  as  is  known  by 
the  great  quantity  frequently  in  these  situations  ejected  by  vomit, 
which  could  not  otherwise  be  supplied.  It  is  probable  the  in- 
crease of  digestion  by  walking  in  frosty  air,  with  many  other  ani- 
mal facts,  may  by  future  observations  be  found  to  be  dependent 
on  this  principle,  as  well  as  the  increased  action  of  the  capilla- 
ries in  continued  fevers  with  weak  pulse. 

Whereas  in  continued  fever  with  strong  pulse,  which  may 
perhaps  occur  sometimes  on  the  first  day  even  of  the  plague,  the 
stomach  with  the  heart  and  arteries  and  the  capillaries  act  by 
direct  sympathy;  that  is,  the  stomach  is  excited  into  stronger 
action  by  increased  irritation  owing  to  the  stimulus  of  conta- 
gious matter;  these  stronger  irritative  motions  of  the  stomach 
excite  a greater  quantity  of  the.  sensorial  power  of  association, 
which  then  actuates  the  heart  and  arteries  with  greater  energy, 
as  these  are  catenated  with  the  stomach;  and  in  the  same  man- 
ner the  increased  actions  of  the  heart  and  arteries  excite  a greater 
quantity  of  the  sensorial  power  of  association,  which  actuates 
the  cutaneous  capillaries  with  increase  of  energy-  See  Class 
IV.  1.  1. 

4.  I shall  dwell  a little  longer  on  this  intricate  subject.  The 
commencement  of  fever-fits  is  known  by  the  inactivity  of  the  cu- 
taneous capillaries,  which  inactivity  is  observable  by  the  paleness 


THEORY  OF  FEVER. 


Scp.  I.  8.  5, 


46  4 

and  coldness  of  the  skin,  and  also  by  the  pain  of  coldness 
which  attends  it.  There  is  nevertheless  in  most  cases,  except 
those  which  are  owing  to  exposure  to  external  cold,  a torpor  of 
the  capillaries  of  some  iniernal  viscus  preceding  this  inactivity 
of  the  cutaneous  capillaries;  which  is  known  by  the  tumour  or 
hardness  of  the  viscus,  or  by  an  aching  pain  of  it.  The  capilla- 
ries of  the  lungs  are  at  the  same  time  rendered  inactive  or  tor- 
pid, as  appears  by  the  difficulty  of  breathing,  and  coldness  of 
the  breath  in  cold  fits  of  fever,  and  in  going  into  the  cold  bath; 
but  the  lungs  are  not  affected  with  the  pain  either  of  coldness  or 
of  torpor. 

One  cause  of  this  synchronous  or  successive  inactivity  of  the 
cutaneous  capillaries,  in  consequence  of  the  previous  torpor  of 
some  internal  viscus,  may  be  owing  to  the  deficiency  of  heat; 
which  must  occur  when  any  part  becomes  inactive;  because 
the  secretions  of  that  part  cease  or  are  lessened,  and  the  quantity 
of  heat  of  it  in  consequence.  But  the  principal  cause  of  it  I 
suppose  to  be  owing  to  the  defect  of  the  sensorial  power  of  as- 
sociation; which  power  of  association  is  excited  by  some  pre- 
vious or  concomitant  motions  of  (he  parts  of  every  great  circle 
of  actions.  This  appears  on  going  into  the  cold  bath,  because 
the  shortness  of  breath  instantly  occurs,  sooner  than  one  can  con- 
ceive the  diminution  of  the  heat  of  the  skin  could  affect  the  lungs 
by  the  want  of  its  stimulus;  but  not  sooner  than  the  defect  of  the 
sensorial  power  of  association  could  affect  them;  because  this 
must  cease  to  be  excited  into  action  on  the  instant  that  the  cu- 
taneous capillaries  cease  to  act;  whence  in  the  first  moment  of 
contact  of  the  cold  water  the  cutaneous  capillaries  cease  to  act 
from  defect  of  irritation;  which  is  caused  by  defect  of  the  stimu- 
lus of  heat;  and  in  the  second  moment  the  capillaries  of  the  lungs 
cease  to  act  from  the  defect  of  association;  which  is  caused  by 
the  defect  of  the  motions  of  the  cutaneous  capillaries.  Thus  die 
universal  torpor  in  the  cold  paroxysm  of  fever  is  an  example  of 
direct  sympathy,  though  occasioned  in  part  by  defect  of  irritation, 
and  in  part  by  defect  of  association. 

5.  Thus  in  walking  out  in  a frosty  morning  the  skin  is  cooled 
by  the  contact  of  the  cold  air,  whence  the  actions  of  its  capil- 
laries are  diminished  for  want  of  their  usual  stimulus  of  heat  to 
excite  a sufficient  quantity  of  the  sensorial  power  of  irrigation. 
Hence  there  is  at  first  a saving  of  the  sensorial  power  of  irrita- 
tion for  the  purpose  of  actuating  the  other  parts  of  the  system 
with  greater  energy.  Secondly,  the  sensorial  power  of  associa- 
tion, which  used  to  be  excited  by  the  motions  of  the  cutaneous 
capillaries,  is  now  not  so  powerfully  excited;  and  in  consequence 
the  parts,  which  constitute  the  next  links  of  the  circles  of  asso- 


Su?.  I.  S.  6. 


THEORY  OF  FEVER. 


465 


dated  motions  are  for  a time  actuated  with  less  energy,  and  a 
temporary  general  chilness  succeeds;  which  is  so  far  similar  to 
the  cold  fit  of  intermittent  fever. 

In  this  situation  there  is  a curious  circumstance  occurs,  which 
merits  peculiar  attention:  after  a short  time,  though  the  exter- 
nal skin  continues  cool  by  its  exposure  to  the  cold  air,  and  the 
actions  of  its  capillaries  are  consequently  diminished,  yet  the  ca- 
pillaries of  the  stomach  act  with  greater  energy;  as  is  known 
by  increased  digestion  and  consequent  hunger,  This  is  to  be 
ascribed  to  the  accumulation  of  the  sensorial  power  of  irritation, 
which  now  excites  by  its  superabundance,  or  overflowing,  as  it 
were,  the  stomach  into  increased  action;  though  it  is  at  the  same 
time  excited  less  powerfully  than  usual  by  the  sensorial  power  of 
association.  Thus  the  accumulation  of  the  sensorial  power  of 
irritation  in  the  vessels  of  the  skin  increases  in  this  case  the  ac- 
tion of  the  stomach  in  the  same  manner  as  an  accumulation  of 
the  sensorial  power  of  association  in  the  heart  and  arteries  in 
fevers  with  weak  pulse  increases  the  action  of  the  capillaries. 

If,  nevertheless,  the  coldness  of  the  skin  be  too  long  continued, 
or  exists  in  too  great  a degree,  so  as  in  some  measure  to  impair 
the  life  of  the  part,  no  further  accumulation  of  the  sensorial 
power  of  irritation  occurs;  and  in  consequence  the  actions  of 
the  stomach  become  less  than  natural  by  the  defect  of  the  sen- 
sorial power  of  association;  which  has  ceased  to  be  excited  by 
the  want  of  action  of  the  cutaneous  capillaries.  Whence  continued 
coldness  of  the  feet  is  accompanied  with  indigestion  and  heart- 
burn. See  Class  IV.  2.  1.6. 

6.  Similar  to  this  when  the  actions  of  the  stomach  are  ren- 
dered torpid  by  the  previous  stimulus  of  a violent  emetic,  and 
its  motions  become  retrograde  in  consequence,  a great  quantity 
of  sensorial  power  is  exerted  on  the  lymphatics  of  the  lungs, 
and  other  parts  of  the  body;  which  excites  them  into  greater 
direct  action,  as  is  evinced  by  the  exhibition  of  digitalis  in  ana- 
sarca. In  this  situation  I suppose  the  emetic  drug  stimulates  the 
muscular  fibres  of  the  stomach  into  too  great  action;  and  that 
in  consequence  a great  torpor  soon  succeeds;  and  that  this  in- 
action of  the  muscular  parts  of  the  stomach  is  not  followed  by 
much  accumulation  of  the  sensorial  power  of  irritation;  be- 
cause that  sensorial  power  is  in  great  measure  exhausted  by  the 
previous  excessive  stimulus.  But  the  lymphatics  of  the  stomach 
have  their  actions  lessened  by  defect  of  the  sensorial  power  of  asso- 
ciation, which  is  not  now  excited  into  action,  owing  to  the  less- 
ened motions  of  the  muscular  parts  of  it,  with  which  the  lym- 
phatics are  associated.  The  sensovial  power  of  association  be- 
comes therefore  accumulated  in  these  lymphatics  of  the  stomach, 

vol.  ir.  3 o 


166 


THEORY  OF  FEVER. 


Sup.  I.  8.  6. 


because  it  is  not  excited  into  action;  exactly  as  the  power  of  irri- 
tation becomes  accumulated  in  the  hand,  when  immersed  in  snow; 
and  this  accumulated  sensorial  power  of  association  excites  the 
lymphatics  of  the  lungs  and  of  other  parts,  which  are  most  nearly 
associated  with  those  of  the  stomach,  into  more  energetic  actions. 
Thus  the  muscular  fibres  of  the  stomach  act  with  the  lymphatics 
of  that  organ  in  direct  sympathy;  and  the  lymphatics  of  the  sto- 
mach act  in  reverse  sympathy  with  those  of  the  lungs  and  of 
other  parts  of  the  body;  the  former  of  which  is  caused  by  defect 
of  the  excitement  of  the  sensorial  power  of  association,  and  the 
latter  by  the  accumulation  of  it. 

Besides  the  efficient  cause,  as  above  explained,  the  final  cause, 
or  convenience  of  these  organic  actions  are  worthy  our  atten- 
tion. In  this  case  of  an  acrid  drug  swallowed  into  the  stomach, 
the  reverted  actions  of  the  muscular  fibres  of  the  stomach  tend 
to  eject  its  enemy;  the  reverted  actions  of  its  lymphatics  pour 
a great  quantity  of  fluids  into  the  stomach  for  the  purpose  of 
diluting  or  washing  off  the  noxious  drug;  and  the  increased 
actions  of  the  other  lymphatics  supply  these  retrograde  ones  of 
the  stomach  with  an  inconceivable  supply  of  fluids,  as  is  seen  in 
Ileus  and  Cholera. 

7.  The  inquisitive  reader  will  excuse  my  continuing  this 
subject,  though  perhaps  with  some  repetitions,  as  it  envelopes 
the  very  essence  of  fever.  When  the  first  link  of  a train  of  ac- 
tions is  excited  by  excessive  stimulus,  or  excessive  irritability,  and 
thus  acts  with  unusual  energy  by  the  increased  quantity  of  irri- 
tation, these  increased  motions  excite  a greater  quantity  of  the 
sensorial  power  of  association,  which  causes  increased  motions 
in  the  second  link,  which  is  catenated  with  the  first;  and  then 
the  excessive  action  of  this  second  link  excites  also  a greater 
quantity  of  the  sensorial  power  of  association,  which  increases 
the  motions  of  the  third  link  of  this  chain  of  association,  and 
thus  the  increase  of  the  stimulus  on  the  irritative  motions,  to 
which  the  chain  of  association  is  catenated,  increases  the  action 
of  the  whole  chain  or  circle  of  associated  motions. 

After  a time  the  irritative  motions  become  torpid  by  expendi- 
ture of  the  sensorial  power  of  irritation,  and  then  the  power  of 
association  also  becomes  less  exerted,  both  because  it  has  been  in 
part  exhausted  by  too  great  action,  and  is  now  less  excited  by  the 
lessened  action  of  the  irritative  motions,  which  used  to  excite  it. 
These  are  both  instances  of  direct  sympathy,  and  frequently  con- 
stitute the  cold  and  hot  fit  of  intermittents. 

But  though  the  accumulation  of  the  sensorial  power  of  irri- 
tation during  the  quiescence  of  some  motion,  owing  to  want  ol 
stimulus,  generally  induces  torpor  in  the  first  link  of  the  train  o: 


Scr.  I.  8.  8. 


THEORY  OF  FEVER. 


461 


associated  motions  catenated  with  it;  as  the  capillaries  of  the 
Jungs  become  torpid  immediately  on  immersion  of  the  skin  into 
cold  water;  yet  in  some  situations  an  orgasm  or  excess  of  action 
is  produced  in  the  first  link  of  the  associated  motions  thus  cate- 
nated with  irritative  ones;  as  in  the  increased  action  of  the  sto- 
mach, when  the  skin  is  for  a time  exposed  to  cold  air;  which 
may  in  part  be  ascribed  to  the  general  increase  of  action  of  the 
whole  system,  owing  to  the  diminished  expenditure  of  sensorial 
power,  but  particularly  of  the  parts,  which  have  habitually  acted 
together;  as  when  one  arm  is  paralytic  the  other  is  liable  to  more 
frequent  or  almost  continual  motion;  and  when  one  eye  becomes 
blind  the  other  frequently  becomes  sponger;  which  is  well  known 
to  farriers,  who  are  said  sometimes  to  destroy  the  sight  of  one 
eye  to  strengthen  that  of  the  other  in  diseased  horses. 

Hence  there  is  sometimes  a direct  sympathy,  and  sometimes  a 
reverse  one  succeeds  the  torpor  occasioned  by  defect  of  stimulus, 
the  latter  of  which  is  perhaps  owing  to  a certain  time  being  re- 
quired for  the  production  of  an  accumulation  of  the  sensorial 
power  of  irritation  by  the  nervous  branches  of  the  torpid  organ; 
which  accumulation  is  now  in  part  or  entirely  derived  to  the  next 
link  of  the  association.  Thus  in  going  into  a coldish  bath,  as 
into  a river  in  the  summer  months,  we  at  first  experience  a diffi- 
culty of  breathing  from  the  torpid  action  of  the  pulmonary  capil- 
laries, owing  to  the  deficient  excitement  of  the  sensorial  power  of 
association  in  consequence  of  the  torpor  of  the  cutaneous  capil- 
laries But  in  a very  short  time,  as  in  one  minute,  the  sensorial 
power  of  irritation  becomes  accumulated  by  the  inactivity  of  the 
cutaneous  capillaries;  and  as  its  superabundance  becomes  now 
expended  on  the  pulmonary  capillaries,  the  difficult  respiration 
ceases;  though  the  cutaneous  capillaries  continue  torpid  by  their 
contact  with  the  cold  w'ater,  and  consequently  the  sensorial  power 
of  association,  which  used  to  contribute  to  actuate  the  pulmonary 
capillaries,  is  less  excited. 

8.  In  like  manner  when  there  exists  an  accumulation  of  the 
sensorial  power  of  association,  owning  to  defect  of  its  excitement 
by  some  previous  irritative  or  associate  motions,  it  is  generally 
accompanied  for  a certain  time  by  a torpor  not  only  of  the  link 
first  affected,  but  of  the  subsequent  parts,  or  of  the  whole  train 
of  associated  motions,  as  in  the  cold  fits  of  intermittent  fevers, 
let  after  a time  an  increased  action  of  the  next  links  of  associat- 
ed motions  succeeds  the  torpor  of  the  first,  as  the  absorbent  ves- 
sels of  the  lungs  act  more  violently  in  consequence  of  the  defi- 
cient action  of  those  of  the  stomach;  and  the  skin  at  the  com- 
mencement of  sickness  is  pale  and  cold,  but  in  a little  time  be- 
comes flushed  and  warm. 


468 


THEORY  OF  FEVER. 


Sup.  I.  8.  9. 


Thus  we  see  in  associate  motions,  which  are  rendered  torpid 
by  defect  of  excitement,  that  sometimes  a direct,  and  sometimes 
a reverse  sympathy  succeeds  in  the  subsequent  links  of  the  chain. 
But  I believe  where  a torpor  of  irritative  or  of  the  associate  mo- 
tions is  caused  by  a previous  too  great  expenditure  or  exhaustion 
of  the  sensorial  powers  of  irritation  or  association,  no  increase  of 
action  in  the  subsequent  link  ever  occurs,  or  not  till  after  a very 
long  time. 

Thus  when  the  stomach  becomes  torpid  by  previous  violent 
exeriion,  and  consequent  exhaustion  of  the  sensorial  power  of 
irritation,  as  after  intoxication  with  wine  or  opium,  or  after  the 
exhibition  of  some  violent  emetic  drug,  the  torpor  is  communi- 
cated to  the  heart  and  arteries,  as  in  continued  fevers  with  weak 
pulse.  But  where  the  torpor  of  the  stomach  is  produced  from 
defective  association,  as  in  sea-sickness;  or  in  the  sickness  which 
occurs,  when  a stone  stimulates  the  ureter;  no  torpor  is  then  com- 
municated to  the  heart  and  arteries.  For  in  the  former  case  there 
is  no  accumulation  of  sensorial  power  in  the  stomach,  which 
was  previously  exhausted  by  too  great  stimulus;  but  in  the  lat- 
ter case  the  accumulation  of  sensorial  power  in  the  stomach  dur- 
ing its  torpor  is  evinced  by  this  circumstance;  that  in  sea-sick- 
ness the  patients  eat  and  drink  voraciously  at  intervals;  and  the 
pulse  is  generally  not  affected  by  the  sickness  occasioned  by  a 
stone  in  the  ureter.  For  the  action  of  the  stomach  is  then  less- 
ened, and  in  consequence  becomes  retrograde,  not  owing  to  the 
exhaustion  of  the  sensorial  power  of  irritation,  but  to  the  want 
of  excitement  of  the  sensorial  power  of  association;  which  is 
caused  by  the  defective  action  of  the  ureter,  which  becomes  oc- 
casionally torpid  by  the  great  stimulus  of  the  stone  it  contains; 
or  which  is  caused  by  the  great  exhaustion  of  sensorial  power  by 
the  pain;  which  affects  the  ureter  without  exciting  inflammation, 
or  increased  action  of  it. 

9.  Thus  though  the  stomach  after  the  great  stimulus  of  in- 
toxication from  excess  of  wine  or  opium  will  continue  many 
hours  without  accumulation  of  sensorial  power,  as  appears  from 
the  patient’s  experiencing  no  appetite  at  the  intervals  of  sick- 
ness; yet  after  long  abstinence  from  food,  at  length  not  only 
the  exhausted  quantity  of  sensorial  power  is  renewed,  but  an  ac- 
cumulation of  it  at  length  occurs,  and  hunger  returns.  In  this 
situation  the  stomach  is  generally  about  a whole  day  before  it  re- 
gains its  usual  powers  of  digestion;  but  if  it  has  been  still  more  vio- 
lently stimulated,  and  its  actions  further  impaired,  a still  more 
permanent  torpor,  along  with  a continued  fever  with  weak  pulse  is 
liable  to  occur;  and  a fourth  part  or  a half,  or  three-fourths,  or  a 


THEORY  OF  FEVER. 


Slip.  I.  8. 10. 


4G9 


whole  lunar  period  passes,  before  it  recovers  its  due  irritability 
and  consequent  action. 

In  similar  manner,  after  a person  has  been  confined  in  a very 
warm  room  for  some  hours,  the  cutaneous  capillaries,  with  their 
secretory  and  absorbent  vessels,  become  exhausted  of  their  senso- 
rial power  of  irritation  by  the  too  great  violent  exertions  occa- 
sioned by  the  unusual  stimulus  of  heat;  and  in  coming  into  a 
colder  atmosphere  an  inactivity  of  the  cutaneous  vessels  exists  at 
first  for  some  time  without  accumulation  of  sensorial  power;  as 
is  shewn  by  the  continuance  of  the  pain  of  cold  and  the  paleness; 
but  after  a time  both  the  pain  of  cold  and  paleness  vanish, 
which  now  indicates  an  accumulation  of  the  sensorial  power  of 
irritation,  as  less  degrees  of  heat  stimulate  the  system  into  due 
action. 

In  the  same  manner,  after  any  one  has  been  some  time  in  the 
summer  sunshine,  on  coming  into  a dark  cell  he  continues  much 
longer  before  he  can  clearly  distinguish  objects,  than  if  his  eyes 
had  only  been  previously  exposed  to  the  light  of  a cloudy  day  in 
winter;  because  the  sensorial  power  of  irritation,  and  consequent 
sensation,  had  in  the  first  case  been  previously  much  expended 
or  exhausted;  and  therefore  required  a much  longer  time  be- 
fore it  could  be  produced  in  the  brain,  or  derived  to  the  optic 
nerves,  in  such  quantity  as  to  restore  the  deficiency,  and  to  cause 
an  accumulation  of  it;  whereas  in  the  latter  case  no  deficiency 
had  occurred. 

10.  Thus  the  accumulation  or  deficiency  of  sensorial  power 
in  a torpid  organ,  which  had  previously  been  accustomed  to  per- 
petual action,  depends  on  the  manner  in  which  it  becomes  tor- 
pid; that  is,  whether  by  great  previous  stimulus,  or  great  previ- 
ous excitement  of  the  powder  of  association;  or  by  defect  of  its 
accustomed  stimulus,  or  of  its  accustomed  excitement  of  the 
power  of  association.  I n the  former  case  the  sensorial  power  is  in 
an  exhausted  state,  and  therefore  is  not  likely  to  become  so  soon 
accumulated,  as  after  drunkenness,  or  exposure  to  great  heat,  or 
to  great  light;  in  the  latter  a great  accumulation  of  sensorial 
power  occurs,  as  after  exposure  to  cold,  or  hunger,  or  darkness. 

Hence  when  the  stomach  continues  torpid  by  previous  vio- 
lent stimulus,  as  in  the  exhibition  of  digitalis,  no  accumulation 
of  sensorial  power  of  irritation  supervenes;  and  in  consequence 
the  motions  of  the  heart  and  arteries,  which  are  associated  with 
those  of  the  stomach,  become  weak,  and  slow  and  intermittent, 
from  the  defect  of  the  excitement  of  the  sensorial  power  of  asso- 
ciation. But  what  follows ? as  the  actions  of  the  heart  and  ar- 
teries are  lessened  by  the  deficient  action  of  the  sensorial  power 
of  association,  and  not  by  previous  increased  excitement  of  it; 


470 


THEORY  OF  FEVER. 


Scp.  I.  8.  11. 


a great  accumulation  of  the  sensorial  power  of  association  occurs, 
which  is  exerted  on  the  pulmonary  and  cutaneous  absorbents  by 
reverse  sympathy,  and  produces  a great  absorption  of  the  fluid 
effused  into  the  cellular  membrane  in  anasarca,  with  dry  skin; 
constituting  one  kind  of  atrophy. 

But  if  at  the  same  time  the  secerning  vessels  of  the  stomach 
are  stimulated  into  so  violent  activity  as  to  induce  great  conse- 
quent torpor,  as  probably  happens  when  contagious  matter  is 
swallowed  into  the  stomach  with  our  saliva,  those  of  the  heart 
and  arteries  act  feebly  from  the  deficient  excitement  of  the  power 
of  association;  and  then  the  cutaneous  and  pulmonary  secerning 
vessels  act  with  greater  force  than  natural,  owfing  to  the  accu- 
mulation of  the  sensorial  power  of  association;  and  unnatural 
heat  of  the  skin,  and  of  the  breath  succeed;  but  without  fre- 
quency of  pulse,  constituting  the  paresis  irritativa  of  Class  I.  2. 
1 . 2.  And  lastly,  if  a paucity  of  blood  attends  this  paresis,  or 
some  other  cause  inducing  a frequency  of  pulse,  the  febris  inirri- 
tativa,  or  fever  with  weak  pulse,  is  produced. 

But  on  the  contrary,  when  the  stomach  has  previously  been 
rendered  torpid  by  defect  of  stimulus,  as  by  hunger,  if  food  be 
too  hastily  supplied,  not  only  great  exertion  of  the  stomach  it- 
self succeeds,  but  fever  with  strong  pulse  is  induced  in  conse- 
quence; that  is,  the  heart  and  arteries  are  excited  into  more  ener- 
getic action  by  the  excess  of  the  power  of  association,  which 
catenates  their  motions  with  those  of  the  stomach.  For  the  re- 
dundancy of  sensorial  powrer  of  irritation,  which  was  accumu- 
lated during  the  inactivity  of  the  stomach,  and  is  now  called  into 
action  by  stimulus,  actuates  that  organ  with  increased  energy, 
and  excites  by  these  increased  motions  the  sensorial  power  of 
association;  which  has  also  been  accumulated  during  the  inacti- 
vity of  the  heart  and  arteries;  and  thus  these  organs  also  are 
now  excited  into  greater  action. 

So  after  the  skin  has  been  exposed  some  hours  to  greater  heat 
than  natural  in  the  warm  room,  other  parts,  as  the  membranes 
of  the  nostrils,  or  of  the  lungs,  or  of  the  stomach,  are  liable  to 
become  torpid  from  direct  sympathy  w'ith  it,  when  we  come  in- 
to air  of  a moderate  temperature;  whence  catarrhs,  coughs,  and 
fevers.  But  if  this  torpor  be  occasioned  by  defect  of  stimulus, 
as  after  being  exposed  to  frosty  air,  the  accumulation  of  sen- 
sorial power  is  exerted,  and  a glow  of  the  skin  follows,  with 
increased  digestion,  full  respiration,  and  more  vigorous  circula- 
tion. 

11.  It  may  be  asked,  Why  is  there  a great  and  constant  accu- 
mulation of  the  sensorial  power  of  association,  owing  to  the  tor- 
por of  the  stomach  and  heart  and  arteries,  in  continued  fever 


Sup.  I.  8.  12. 


THEORY  OF  FEVER. 


471 


with  weak  pulse;  which  is  exerted  on  the  cutaneous  and  pul- 
monary capillaries,  so  as  to  excite  them  into  increased  action 
for  many  weeks,  and  yet  no  such  exuberance  of  sensorial  power 
produces  fever  in  winter-sleeping  animals,  or  in  chlorosis,  or 
apepsia,  or  hysteria? 

In  winter-sleeping  animals  I suppose  the  whole  nervous  sys- 
tem is  torpid,  or  paralysed,  as  in  the  sleep  of  frozen  people; 
and  that  the  stomach  is  torpid  in  consequence  of  the  inactivity 
or  quiescence  of  the  brain;  and  that  all  other  parts  of  the  body, 
and  the  cutaneous  capillaries  with  the  rest,  labour  under  a simi- 
lar torpor. 

In  chlorosis,  I imagine,  the  actions  of  the  heart  and  arteries, 
as  well  as  those  of  the  cutaneous  and  pulmonary  capillaries,  suf- 
fer along  with  those  of  the  stomach  from  the  deficient  stimulus 
of  the  pale  blood;  and  that  though  the  liver  is  probably  the  seat 
of  the  original  torpor  in  this  disease,  with  which  all  other  parts 
sympathize  from  defect  of  the  excitation  of  the  sensorial  power  of 
association;  yet  as  this  torpor  occurs  in  so  small  a degree  as  not 
to  excite  a shuddering  or  cold  fit,  no  observable  consequences  are 
in  general  occasioned  by  the  consequent  accumulation  of  senso- 
rial power.  Sometimes  indeed  in  chlorosis  there  does  occur 
a frequent  pulse  and  hot  skin;  in  which  circumstances  I sup- 
pose the  heart  and  arteries  are  become  in  some  degree  torpid  by 
direct  sympathy  with  the  torpid  liver;  and  that  hence  not  only 
the  pulse  becomes  frequent,  but  the  capillaries  of  the  skin  act 
more  violently  by  reverse  sympathy  with  the  heart  and  arteries, 
owing  to  the  accumulation  of  the  sensorial  power  of  association 
in  them  during  their  torpid  state,  as  occurs  in  irritative  fever. 
See  Article  11.  of  this  Supplement. 

In  apepsia  chronica  the  actions  of  the  stomach  are  not  so  far 
impaired  or  destroyed  as  totally  to  prevent  the  excitation  of  the 
sensorial  power  of  association,  which  therefore  contributes  some- 
thing towards  the  actions  of  the  heart  and  arteries,  though  less 
than  natural,  as  a weak  pulse  always  I believe  attends  this  dis- 
ease. 

There  is  a torpor  of  the  stomach,  and  of  the  upper  part  of 
the  alimentary  canal  in  hysteria,  as  is  evident  from  the  retro- 
grade actions  of  the  duodenum,  stomach,  and  oesophagus,  which 
constitute  the  globus  hystericus,  or  sensation  of  a globe  rising  in- 
to the  throat.  But  as  these  retrograde  actions  are  less  than  those 
which  induce  sickness  or  vomiting,  and  are  not  occasioned  by 
previous  exhaustion  of  the  sensorial  power  of  irritation,  they  do 
not  so  totally  prevent  the  excitement  of  the  sensorial  power  of 
association,  as  to  lessen  the  motion  of  the  heart  and  arteries  so 
much  as  to  induce  fever;  yet  in  this  case,  as  in  apepsia,  and  in 


472 


THEORY  OF  FEVER, 


S \ie.  I.  8.  12 


chlorosis,  the  pulsations  of  the  heart  and  arteries  are  weaker  than 
natural,  and  are  sometimes  attended  with  occasionally  increased 
action  of  the  capillaries;  as  appears  from  the  flushings  of  the 
face,  and  hot  skin,  which  generally  form  an  evening  febricula  in 
diseases  attended  with  weak  digestion. 

12.  The  increased  action  or  orgasm,  of  the  cutaneous,  pul- 
monary, and  cellular  capillaries,  with  their  secerning  and  absorb- 
ent  vessels,  in  those  fevers  which  are  attended  with  deficiency 
of  vital  action,  exhausts  the  patient  both  by  the  additional  ex- 
penditure of  sensorial  power  on  those  organs  of  secretion,  and 
by  the  too  great  absorption  of  the  mucus  and  fat  of  the  body; 
whence  great  debility  and  great  emaciation.  Hence  one  great 
indication  of  cure  of  continued  fever  with  arterial  debility  is  to 
diminish  the  too  great  action  of  the  capillaries;  which  is  to  be 
done  by  frequent  ablutions,  or  bathing  the  whole  skin  in  tepid 
or  in  cold  water,  as  recommended  by  Dr.  Currie  of  Liverpool, 
(Philos.  Trans,  for  1792,)  for  half  an  hour,  twice  a day,  or  at 
those  times  when  the  skin  feels  driest  and  hottest.  Much  cool 
air  should  also  be  admitted,  when  the  breath  of  the  patient  feels 
hot  to  one’s  hand;  or  tvhen  the  tongue,  especially  its  middle 
part  is  dry,  and  covered  with  a crust  of  indurated  mucus;  as* 
these  indicate  the  increased  action  of  the  pulmonary  capillaries; 
in  the  same  manner  as  the  dry  and  hot  skin  indicates  the  orgasm 
of  the  cutaneous  capillaries;  and  the  emaciation  of  the  body  that 
of  the  cellular  ones. 

For  this  purpose  of  abating  the  action  of  the  capillaries  by 
frequent  ablution  or  fomentation,  water  of  any  degree  of  heat 
beneath  that  of  the  body  will  be  of  service,  and  ought  in  accu- 
rate language  to  be  called  a cold  bath;  but  the  degree  of  cold- 
ness, where  the  patient  is  sensible,  should  in  some  measure  be 
governed  by  his  sensations;  as  it  is  probable,  that  the  degree  of 
coldness,  which  is  most  grateful  to  him,  will  also  be  of  the  great- 
est benefit  to  him.  See  Class  III.  2.  1.  12.  and  Article  15.  of 
this  Supplement. 

Another  great  use  of  frequent  ablutions,  or  fomentations,  or 
baths,  in  fevers,  where  the  stomach  is  in  some  degree  torpid,  is 
to  supply  the  system  with  aqueous  fluid  by  means  of  the  cutane- 
ous absorbents;  which  is  dissipated  faster  by  the  increased  ac- 
tion of  the  secerning  capillaries,  than  the  stomach  can  furnish, 
and  occasions  great  thirst  at  the  intervals  of  the  sickness. 

IX.  Torpor  of  the  Lungs. 

1.  The  lungs  in  many  cases  of  contagion  may  first  be  affect- 
ed with  torpor,  and  the  skin  become  cold  by  sympathy;  in  the 


tip.  I.  5.  2. 


THEORY  OF  FEVER. 


473 


same  manner  as  a cold  skin  on  going  into  the  cold  bath  induces 
difficulty  of  breathing.  Or  the  stomach  may  become  affected 
with  torpor,  by  its  sympathy  with  the  lungs,  as  in  the  experi- 
ments of  Mr.  Watt  with  hydrocarbonate  gas;  a few  respirations 
of  which  induced  sickness,  and  even  syncope.  When  the  sto- 
mach or  skin  is  thus  affected  secondarily  by  association,  an  accu- 
mulation of  sensorial  power  occurs  much  sooner,  than  when  these 
parts  become  torpid  in  consequence  of  previous  excess  of  stimu- 
lus; and  hence  they  sooner  recover  their  accustomed  action,  and 
the  fever  ceases.  The  particles  of  contagious  matter  thus 
received  by  respiration,  somewhat  resemble  in  their  effects  the 
acid  gases  from  burning  sulphur,  or  from  charcoal;  which,  if 
they  do  not  instantly  destroy,  induce  a fever,  and  the  patient 
slowly  recovers. 

2.  I was  some  years  ago  stooping  down,  to  look  which  way 
the  water  oozed  from  a morass,  as  a labourer  opened  it  with  a 
spade,  to  detect  the  source  of  the  spring,  and  inhaled  a vapour 
which  occasioned  an  instant  sense  of  suffocation.  Immediately 
recoiling,  I believe  I inhaled  it  but  once;  yet,  a few  hours  after- 
wards, in  the  cool  of  the  evening,  when  I returned  home  rather 
fatigued  and  hungry,  a shivering  and  cold  fit  occurred,  which  was 
followed  by  a hot  one;  and  the  whole  disease  began  and  termi- 
nated in  about  twelve  hours  without  return.  In  this  case,  the 
power  of  fear,  or  of  imagination,  was  not  concerned;  as  I neither 
thought  of  the  bad  air  of  a morass  before  I perceived  it,  nor  ex- 
pected a fever-fit  till  it  occurred. 

In  this  case,  the  torpor  commenced  in  the  lungs,  and,  after  a 
few  hours,  by  the  addition  of  fatigue,  and  cold,  and  hunger,  was 
propagated,  by  direct  sympathy,  to  the  rest  of  the  system.  An 
orgasm,  or  increased  action  of  the  whole  system,  was  then  in- 
duced, by  the  accumulation  of  sensorial  power  of  irritation  in  the 
lungs,  and  of  association  in  the  other  organs;  and,  when  these 
subsided,  the  disease  ceased.  It  may  be  asked,  could  a torpor 
of  the  capillaries  of  the  air-vessels  of  the  lungs  be  so  suddenly 
produced  by  great  stimulation? — It  appears  probable,  that  it 
might,  because  great  exertion  of  irritative  motions  may  be  in- 
stantly produced  without  our  perceiving  them;  that  is,  without 
their  being  attended  by  sensation,  both  in  the  lungs  and  stomach; 
and  the  organs  may  become  torpid  by  the  great  expenditure  of 
the  sensorial  power  of  irritation  in  an  instant  of  time;  as  para- 
lysis frequently  instantly  follows  too  great  an  exertion  of  volun- 
tary power. 

3.  When  the  capillaries  of  the  lungs  act  too  violently,  as  in 
some  continued  fevers;  which  is  known  by  the  heat  of  the  breath, 
and  by  the  dryness  of  the  tongue,  especially  of  the  middle  part 

VOL.  II.  3 p 


THEORY  OF  FEVER. 


Sc?.  I.  10.  1. 


414 

of  it;  not  only  cooler  air  might  be  admitted  more  freely  into  a 
sick  room,  to  counteract  this  orgasm  of  the  pulmonary  capillaries; 
but  perhaps  the  patient  might  breathe  with  advantage  a mixture 
of  carbonic  acid  gas,  or  of  hydrogene  gas,  or  of  azote  with  atmo- 
spheric air.  And,  on  the  contrary,  when  there  exists  an  evident 
torpor  of  the  pulmonary  capillaries,  which  may  be  known  by  the 
correspondent  chilness  of  the  skin;  and  by  a tickling  cough, 
which  sometimes  attends  cold  paroxysms  of  fever,  and  is  then 
owing  to  the  deficient  absorption  of  the  pulmonary  mucus,  the 
saline  parts  of  which  stimulate  the  bronchiae,  or  air-vessels;  a 
mixture  of  one  part  of  oxygen  gas  with  10  or  20  parts  of  atmo- 
spheric air,  might  probably  be  breathed  with  great  advantage. 

X.  Torpor  of  the  Brain. 

As  the  inactivity  or  torpor  of  the  absorbent  vessels  of  the  brail* 
is  the  cause  of  hydrocephalus  internus;  and  as  the  deficiency  of 
venous  absorption  in  the  brain,  or  torpor  of  the  extremities  of  its 
veins,  is  believed  frequently  to  be  the  cause  of  apoplexies;  so 
there  is  reason  to  conclude,  that  the  torpor  of  the  secerning  ves- 
sels of  the  brain,  which  are  supposed  to  produce  the  sensorial 
power,  may  constitute  the  immediate  cause  of  some  fevers  with 
arterial  debility.  And  also  that  the  increased  action  of  these  se- 
cerning vessels  may  sometimes  constitute  the  immediate  cause  of 
fevers  with  arterial  strength. 

It  is  nevertheless  probable,  that  the  torpor  or  orgasm  of  the 
sanguiferous,  absorbent,  or  secerning  vessels  of  the  brain  may 
frequently  exist  as  a secondary  effect,  owing  to  their  association 
with  other  organs,  as  the  stomach  or  lungs;  and  may  thus  be  pro- 
duced like  the  torpor  of  the  heart  and  arteries  in  inirritative 
fevers,  or  like  the  orgasm  of  those  organs  in  irritative  fevers,  or 
inflammatory  ones. 

Where  there  exists  a torpor  of  the  brain,  might  not  very  slight 
electric  shocks,  passed  frequently  through  it  in  all  directions,  be 
used  with  advantage?  Might  not  fomentations  of  94  or  96  de- 
grees of  heat  on  the  head  for  an  hour  at  a time,  and  frequently 
repeated,  stimulate  the  brain  into  action;  as  in  the  revival  of 
winter-sleeping  animals  by  warmth?  Ether  externally  might  be 
frequently  applied,  and  a blister  on  the  shaved  head. 

Where  the  secerning  vessels  of  the  brain  act  with  too  great 
energy,  as  in  some  inflammatory  fevers,  might  it  not  be  dimi- 
nished by  laying  the  patient  horizontally  on  a mill-stone,  and 
whirling  him  till  sleep  should  be  produced,  as  the  brain  becomes 


THEORY  OF  FEVER. 


Sot.  I.  11.  1. 


475 


compressed  by  the  centrifugal  force?  See  Article  15.  of  this 
Supplement. 

XI.  Torpor  of  the  Heart  and  Arteries. 

1.  It  was  shewn  in  Class  IV.  1. 1.  6.  in  IV.  2.  1.2.  and  in 
Suppl.  I.  6.  3.  that  a reverse  sympathy  generally  exists  between 
the  lacteal  and  lymphatic  branches  of  the  absorbent  system. 
Hence,  when  the  motions  of  the  absorbents  of  the  stomach  are 
rendered  torpid  or  retrograde  in  fevers  with  arterial  debility, 
those  of  the  skin,  lungs,  and  cellular  membrane,  act  with  in- 
creased energy.  But  the  actions  of  the  muscular  fibres  of  the 
heart  and  arteries  are  at  the  same  time  associated  with  those  of 
the  muscular  fibres  of  the  stomach  by  direct  sympathy.  Both 
these  actions  occur  during  the  operation  of  powerful  emetics,  as 
squill  or  digitalis;  while  the  motions  of  the  stomach  continue 
torpid  or  retrograde,  the  cellular  and  cutaneous  absorbents  act 
with  greater  energy,  and  the  pulsations  of  the  heart  and  arteries 
become  weaker,  and  sometimes  slower. 

The  increased  action  of  the  stomach  after  a meal,  and  of  the 
heart  and  arteries  at  the  same  time  from  the  stimulus  of  the  new 
supply  of  chyle,  seems  originally  to  have  produced,  and  to 
have  established  this  direct  sympathy  between  them.  As  the 
increased  action  of  the  absorbents  of  the  stomach  after  a meal 
has  been  usually  attended  with  diminished  action  of  the  other 
branches  of  the  absorbent  system,  as  mentioned  in  Class  IV. 
1.  1.  6.  and  has  thus  established  a reverse  sympathy  between 
them. 

2.  Besides  the  reverse  sympathy  of  the  absorbent  vessels  of  the 
muscles  of  the  stomach,  and  of  the  heart  and  arteries,  with  those 
of  the  skin,  lungs,  and  cellular  membrane;  there  exists  a similar 
reverse  sympathy  between  the  secerning  vessels  or  glands  of  the 
former  of  these  organs  with  those  of  the  latter;  that  is,  the  mu- 
cous glands  of  the  heart  and  arteries  act  generally  by  direct  sym- 
pathy with  those  of  the  stomach;  and  the  mucous  glands  of  the 
cellular  membrane  of  the  lungs,  and  of  the  skin,  act  by  reverse 
sympathy  with  them  both. 

Hence  when  the  stomach  is  torpid,  as  in  sickness,  this  torpor 
sometimes  only  affects  the  absorbent  vessels  of  it;  and  then  the 
absorbents  of  the  cellular  membrane  and  the  skin  only  act  with 
increased  energy  by  reverse  sympathy.  If  the  torpor  affects  the 
muscular  fibres  of  the  stomach,  those  of  the  heart  and  arteries 
act  by  direct  sympathy  with  it,  and  a weak  pulse  is  produced, 
as  in  the  exhibition  of  digitalis,  but  without  increase  of  heat. 
But  if  the  torpor  also  affects  the  glands  of  the  stomach,  the  cu» 


476 


THEORY  OF  FEVER. 


Scp.  I.  11.  S. 


taneous  and  pulmonary  glands  act  with  greater  energy  by  their 
reverse  sympathy  with  those  of  the  stomach,  and  of  the  heart 
and  arteries;  and  great  heat  is  produced  along  with  increased 
perspiration  both  from  the  skin  and  lungs. 

3.  There  is  some  difficulty  in  explaining,  why  the  actions  of 
the  extensive  system  of  capillary  glands,  which  exist  on  every 
other  membrane  and  cell  in  the  body  for  the  purpose  of  secreting 
mucus  and  perspirable  matter,  should  so  generally  act  by  reverse 
sympathy  with  those  of  the  stomach  and  upper  part  of  the  in- 
testines. It  was  shewn  in  Class  IV.  1.  1.6.  that  when  the  sto- 
mach was  filled  with  solid  and  fluid  aliment,  the  absorbents  of 
the  cellular  membrane,  and  of  the  bladder,  and  of  the  skin,  acted 
with  less  energy;  as  the  fluids,  they  were  used  to  absorb  and 
transmit  into  the  circulation,  were  now  less  wanted;  and  that 
hence  by  habit  a reverse  sympathy  obtained  between  these 
branches  of  the  absorbents  of  the  alimentary  canal,  and  those  of 
the  other  parts  of  the  body. 

Now,  as  at  this  time  less  fluid  wras  absorbed  by  the  cutane- 
ous and  cellular  lymphatics,  it  would  happen,  that  less  would  be 
secreted  by  their  correspondent  secerning  vessels,  or  capillary 
glands;  and  that  hence  by  habit  these  secerning  vessels  would 
acquire  a reverse  sympathy  of  action  with  the  secerning  vessels 
of  the  alimentary  canal. 

Thus  when  the  absorption  of  the  tears  by  the  puncta  lachry- 
malia  is  much  increased  by  the  stimulus  of  snuff;  or  of  an  af- 
fecting idea,  on  the  nasal  ducts,  as  explained  in  Sect.  XVI.  8. 
2.  a great  increase  of  the  secretion  of  tears  from  the  lachrymal 
glands  is  produced  by  the  direct  sympathy  of  the  action  of  these 
glands  with  those  of  their  correspondent  absorbents;  and  that 
though  in  this  case  they  are  placed  at  so  great  a distance  from 
each  other. 

4.  A difficult  question  here  occurs;  why  does  it  happen,  that 
in  fevers  with  weak  pulse  the  contractions  of  the  heart  and  ar- 
teries become  at  the  same  time  more  frequent;  which  also  some- 
times occurs  in  chlorosis,  and  in  some  hysteric  and  hypochon- 
driac diseases,  and  in  some  insanities;  yet  at  other  times  the 
weak  pulse  becomes  at  the  same  time  slow,  as  in  the  exhibition 
of  digitalis,  and  in  paresis  irritativa,  described  in  Class  I.  2.  1.  2. 
which  may  be  termed  a fever  with  slow  pulse?  this  frequency 
of  pulse  cannot  depend  upon  heat,  because  it  sometimes  exists 
without  heat,  as  towards  the  end  of  some  fevers  with  debility. 

Now  as  apoplexies,  which  are  sometimes  ascribed  to  fulness 
of  blood,  are  attended  with  slow  pulse;  and  as  in  animals  dying 
in  the  slaughter-house  from  deficiency  of  blood  the  pulse  be- 
comes frequent  in  extreme;  may  not  the  frequency  of  pulse  in 


Sup.  I.  11.  1. 


THEORY  OF  FEVER, 


477 


fevers  with  arterial  debility  be  in  general  owing  to  paucity  of 
blood?  as  explained  in  Sect.  XXXII.  2.  3.  and  its  slowness  in 
paresis  irritativa  be  caused  by  the  debility  being  accompanied 
with  due  quantity  of  blood?  or  may  not  the  former  circumstance 
sometimes  depend  on  a concomitant  affection  of  the  brain  ap- 
proaching to  sleep?  or  to  the  unusual  facility  of  the  passage  of 
the  blood  through  the  pulmonary  and  aortal  capillaries?  in  which 
circumstance  the  heart  may  completely  empty  itself  at  each  pul- 
sation, though  its  contractions  may  be  weak.  While  the  latter 
depends  on  the  difficulty  of  the  passage  of  the  blood  through  the 
pulmonary  or  aortal  capillaries,  as  in  the  cold  fits  of  intermittents, 
and  in  some  palpitations  of  the  heart,  and  in  some  kinds  of  hm- 
moptoe;  in  these  cases  the  increased  resistance  prevents  the 
heart  from  emptying  itself,  and  in  consequence  a new  diastole 
sooner  occurs,  and  thus  the  number  of  pulsations  becomes  greater 
in  a given  time. 

5.  In  respect  to  the  sympathies  of  action,  which  produce  or 
constitute  fever  with  debility,  the  system  may  be  divided  into 
certain  provinces,  which  are  essentient  or  opposite  to  each  other. 
First,  the  lacteals  or  absorbent  vessels  of  the  stomach,  and  upper 
part  of  the  intestines;  secondly,  the  lymphatics  or  all  the  other 
branches  of  the  absorbent  vessels,  which  arise  from  the  skin, 
mucous  membranes,  cellular  membranes,  and  the  various  glands. 
These  two  divisions  act  by  reverse  sympathy  with  each  other  in 
the  hot  fits  of  fever  with  debility,  though  by  direct  sympathy  in 
the  cold  ones.  The  third  division  consists  of  the  secerning  ves- 
sels of  the  stomach  and  upper  intestines;  and  the  fourth  of  the 
secerning  vessels  of  all  the  other  parts  of  the  body,  as  the  capil- 
lary glands  of  the  skin,  lungs,  and  cellular  membrane,  and  the 
various  other  glands  belonging  to  the  sanguiferous  system.  Many 
of  these  frequently,  but  the  capillaries  always,  act  by  reverse 
sympathy  with  those  of  the  third  division  above  mentioned  in  the 
hot  fits  of  fever  with  debility,  though  by  direct  sympathy  with 
them  in  the  cold  fits.  Fifthly,  the  muscular  fibres  of  the  stomach, 
and  upper  intestines;  and  sixthly,  the  muscular  fibres  of  the  heart 
and  arteries.  The  actions  of  these  two  last  divisions  of  moving 
fibres  act  by  direct  sympathy  with  each  other,  both  in  the  cold 
and  hot  fits  of  fevers  with  debility. 

The  efficient  cause  of  those  apparent  sympathies  in  fevers 
with  weak  pulse  may  be  thus  understood.  In  the  cold  paroxysm 
of  fever  with  weak  pulse,  the  first  part  affected  I believe  to  be 
the  stomach,  and  that  it  has  become  torpid  by  previous  violent 
exertion,  as  by  swallowing  contagious  matter  mixed  with  saliva, 
and  not  by  defect  of  stimulus;  as  from  cold  or  hunger.  The 
actions  of  this  important  organ,  which  sympathizes  with  almost 


478 


THEORY  OF  FEVER. 


Scp.  I.  11.  6. 


every  part  of  the  body,  being  thus  much  diminished  or  nearly 
destroyed,  the  sensorial  power  of  association  is  not  excited; 
which  in  health  contributes  to  move  the  heart  and  arteries,  and 
all  the  rest  of  the  system;  whence  an  universal  torpor  occurs. 

When  the  hot  fit  approaches,  the  stomach  in  fevers  with 
strong  pulse  regains  its  activity  by  the  accumulation  of  the  sen- 
sorial power  either  of  irritation,  if  it  was  the  part  first  affected, 
or  of  association,  if  it  was  affected  in  sympathy  with  some  other 
torpid  part,  as  the  spleen  or  liver;  which  accumulation  is  pro- 
duced during  its  torpor.  At  the  same  time  all  the  other  parts 
of  the  system  acquire  greater  energy  of  action  by  the  accumula- 
tion of  the  sensorial  power  of  association,  which  was  produced, 
during  their  inactivity  in  the  cold  fit. 

But  in  fevers  with  weak  pulse  the  stomach,  in  which  the  sen- 
sorial power  of  irritation  had  been  previously  exhausted  by  vio- 
lent action,  acquires  no  such  quick  accumulation  of  sensorial 
power,  but  remains  in  a state  of  torpor  after  the  hot  fit  com- 
mences. The  heart  and  arteries  remain  also  in  a state  of  torpor, 
because  there  continues  to  be  no  excitement  of  their  power  of 
association  owing  to  the  torpid  motions  of  the  stomach;  but 
hence  it  happens,  that  there  exists  at  this  time  a great  accumu- 
lation of  the  power  of  association  in  the  less  active  fibres  of  the 
heart  and  arteries;  which,  as  it  is  not  excited  and  expended  by 
them,  increases  the  associability  of  the  next  link  of  the  associated 
chain  of  motions,  which  consists  of  the  capillaries  or  other 
glands;  and  that  in  so  great  a degree  as  to  actuate  them  with 
unnatural  energy,  and  thus  to  produce  a perpetual  hot  fit  of 
fever.  Because  the  associability  of  the  capillaries  is  so  much 
increased  by  the  accumulation  of  this  power,  owing  to  the  lessened 
activity  of  the  heart  and  arteries,  as  to  overbalance  the  less- 
ened excitement  of  it  by  the  weak  movements  of  the  heart  and 
arteries. 

6.  When  the  accumulation  of  the  sensorial  power  of  irrita- 
tion caused  by  defect  of  stimulus  is  greater  in  the  first  link  of  a 
train  of  actions,  to  which  associated  motions  are  catenated,  than 
the  deficiency  of  the  excitement  of  the  sensorial  power  of  asso- 
ciation in  the  next  link,  what  happens? — the  superabundance  of  the 
unemployed  sensorial  power  of  the  first  link  is  derived  to  the 
second;  the  associability  of  which  thus  becomes  so  greatly  in- 
creased, that  it  acts  more  violently  than  natural,  though  the  ex- 
citement of  its  power  of  association  by  the  lessened  action  of  the 
first  link  is  less  than  natural.  So  that  in  this  situation  the  with- 
drawing of  an  accustomed  stimulus  in  some  parts  of  the  system 
will  decrease  the  irritative  motions  of  that  part,  and  at  the  same 


THEORY  OF  FEVER. 


Sup.  J.  11.  6, 


419 


time  occasion  an  increase  of  the  associate  motion  of  another  part, 
which  is  catenated  with  it. 

This  circumstance  nevertheless  can  only  occur  in  those  parts 
of  the  system  whose  natural  actions  are  perpetual,  and  the  ac- 
cumulation of  sensorial  power  on  that  account  very  great, 
when  their  activity  is  much  lessened  by  the  deduction  of  their 
usual  stimulus;  and  are  therefore  only  to  be  found  in  the  san- 
guiferous system,  or  in  the  alimentary  canal,  or  in  the  glands  and 
capillaries.  Of  the  first  of  which  the  following  is  an  instance. 

The  respiration  of  a reduced  atmosphere,  that  is,  of  air  mixed 
with  hydrogene  or  azote,  quickens  the  pulse,  as  observed  in  the 
case  of  Mrs.  Eaton  by  Dr.  Reynolds  and  Dr.  Thornton;  to 
which  Dr.  Beddoes  adds  in  a note,  that  “ he  never  saw  an  in- 
stance in  which  a lowered  atmosphere  did  not  at  the  moment 
quicken  the  pulse,  while  it  weakened  the  action  of  the  heart 
and  arteries.”  Considerations  on  Factitious  Airs,  by  Thomas 
Beddoes  and  James  Watt,  Part  III.  p.  67.  Johnson,  London. 
By  the  assistance  of  this  new  fact,  the  curious  circumstance  of 
the  quick  production  of  warmth  of  the  skin  on  covering  the 
head  under  the  bed-clothes,  which  every  one  must  at  some  time 
have  experienced,  receives  a more  satisfactory  explanation,  than 
that  which  is  given  in  Class  IV.  1.  1.2.  which  was  printed  be- 
fore this  part  of  Dr.  Beddoes’s  Considerations  was  published. 

For  if  the  blood  be  deprived  of  its  accustomed  quantity  of  oxy- 
gen, as  in  covering  the  head  in  bed,  and  thus  breathing  an  air 
rendered  impure  by  repeated  respiration,  or  by  breathing  a fac- 
titious air  with  less  proportion  of  oxygen,  which  in  common  re- 
spiration passes  through  the  moist  membranes  of  the  lungs,  and 
mixes  with  the  blood,  the  pulsations  of  the  heart  and  arteries 
become  weaker,  and  consequently  quicker,  by  the  defect  of  the 
stimulus  of  oxygen.  And  as  these  vessels  are  subject  to  perpe- 
tual motion,  the  accumulation  of  the  sensorial  power  of  irrita- 
tion becomes  so  great  by  their  lessened  activity,  that  it  excites 
the  vessels  next  connected,  the  cutaneous  capillaries  for  instance, 
into  more  energetic  actions,  so  as  to  produce  increased  heat  of 
the  skin,  and  greater  perspiration. 

How  exactly  this  resembles  a continued  fever,  with  weak  and 
quick  pulse! — in  the  latter  the  action  of  the  heart  and  arteries 
are  lessened  by  defect  of  the  excitement  of  the  sensorial  power  of 
association,  owing  to  the  torpor  or  lessened  actions  of  the  sto- 
mach; hence  the  accumulation  of  the  sensorial  power  of  associa- 
tion in  this  case,  as  the  accumulation  of  that  of  irritation  in  the 
former,  becomes  so  abundant  as  to  excite  into  increased  action 
the  parts  most  nearly  connected,  as  the  cutaneous  capillaries. 

In  respect  to  the  circumstance  mentioned  by  Sydenham,  that 


480 


THEORY  OF  FEVER. 


Stjp.  I.  11.  7. 


covering  the  head  in  bed  in  a short  time  relieved  the  pertina- 
cious sickness  of  the  patient,  it  must  be  observed  that  when  the 
action  of  the  heart  and  arteries  becomes  weakened  by  the  want 
of  the  due  stimulus  of  the  proper  quantity  of  oxygen  in  the 
blood,  an  accumulation  of  the  sensorial  power  of  irritation  oc- 
curs in  the  fibres  of  the  heart  and  arteries,  which  then  is  ex 
pended  on  those  of  the  capillary  glands,  increasing  their  actions 
and  consequent  secretions  and  heat.  And  then  the  stomach  is 
thrown  into  stronger  action,  both  by  the  greater  excitement  of 
its  natural  quantity  of  the  sensorial  power  of  association  by  the 
increased  actions  of  the  capillaries,  and  also  by  some  increase  of 
associabiiity,  as  it  had  been  previously  a long  time  in  a state  of 
torpor  or  less  activity  than  natural,  as  evinced  by  its  perpetual 
sickness. 

In  a manner  somewhat  similar  to  this,  is  the  redness  of  the 
skin  produced  in  angry  people  by  the  superabundance  of  the  un- 
employed sensorial  power  of  volition,  as  explained  in  Class  IV. 
2.  3.  5.  Rubor  ex  ira.  From  hence  we  learn  how,  when 
people  in  fevers  with  weak  pulse,  or  in  dropsies,  become  insane, 
the  abundance  of  the  unemployed  sensorial  power  of  volition 
increases  the  actions  of  the  whole  moving  system,  and  cures 
those  diseases. 

7.  As  the  orgasm  of  the  capillaries  in  fevers  with  weak  pulse 
is  immediately  caused  by  the  torpid  actions  of  the  heart  and  ar- 
teries, as  above  explained,  this  supplies  us  with  another  indica- 
tion of  cure  in  such  fevers,  and  that  is  to  stimulate  these  organs. 
This  may  probably  be  done  by  some  kind  of  medicines,  which 
are  known  to  pass  into  the  blood  unchanged  in  some  of  their 
properties.  It  is  possible  that  nitre,  or  its  acid,  may  pass  into  the 
blood  and  increase  the  colour  of  it,  and  thus  increase  its  stimu- 
lus, and  the  same  may  be  supposed  of  other  salts,  neutral  or  me- 
tallic? As  rubia  tinctoria,  madder,  colours  the  bones  of  young 
animals,  it  must  pass  into  the  blood  with  its  colouring  matter 
at  least  unchanged,  and  perhaps  many  other  medicines  may 
likewise  alfect  the  blood,  and  thus  act  by  stimulating  the  heart 
and  arteries,  as  well  as  by  stimulating  the  stomach;  which  cir- 
cumstance deserves  further  attention. 

Another  way  of  immediately  stimulating  the  heart  and  arte- 
ries would  be  by  transfusing  new  blood  into  them.  It  is  possible 
that  any  other  fluid  besides  blood,  as  chyle,  or  milk,  or  water, 
could,  if  managed  with  great  art,  be  introduced  safely  or  advan- 
tageously into  the  vein  of  a living  animal? 

A third  method  of  exciting  the  heart  and  arteries  immediately 
is  by  increasing  the  natural  stimulus  of  the  blood,  and  is  well 
worthy  experiment  in  all  fevers  with  weak  pulse;  and  that  con- 


Stir.  I.  12.  1. 


THEORY  OF  FEVER. 


481 


in  supplying  the  blood  with  a greater  proportion  of  oxygen; 
which  may  be  done  by  respiration,  if  the  patient  -was  to  breathe 
either  oxygen  gas  pure,  or  diluted  with  atmospheric  air,  which 
might  be  given  to  many  gallons  frequently  in  a day,  and  by  pass- 
ing through  the  moist  membranes  of  the  lungs,  according  to  the 
experiments  of  Dr.  Priestley,  and  uniting  with  the  blood,  might 
render  it  more  stimulant,  and  thus  excite  the  heart  and  arteries 
into  greater  action ! May  not  some  easier  method  of  exhibiting 
oxygen  gas  by  respiration  be  discovered,  as  by  using  very  small 
quantities  of  hyper-oxygenated  marine  acid  gas  very  much  diluted 
with  atmospheric  air? 

XII.  Torpor  of  the  Stomach  and  Upper  Intestines. 

1 . The  principal  circumstance,  which  supports  the  increased 
action  of  the  capillaries  in  continued  fever  with  weak  pulse,  is 
their  reverse  sympathy  with  those  of  the  stomach  and  upper  in- 
testines, or  with  those  of  the  heart  and  arteries.  The  torpor  of 
the  stomach  and  upper  intestines  is  apparent  in  continued  fevers 
from  the  total  want  of  appetite  for  solid  food,  beside  the  sickness 
with  which  fevers  generally  commence,  and  the  frequent  diarrhoea 
with  indigested  stools,  at  the  same  time  the  thirst  of  the  patient  is 
sometimes  urgent  at  the  intervals  of  the  sickness.  Why  the 
stomach  can  at  this  time  take  fluids  by  intervals,  and  not  solids, 
is  difficult  to  explain;  exeept  it  be  supposed,  as  some  have  affirm- 
ed, that  the  lacteal  absorbents  are  a different  branch  from  the 
lymphatic  absorbents,  and  that  in  this  case  the  former  only  are  in 
a state  of  permanent  torpor. 

2.  The  torpor  of  the  heart  and  arteries  is  known  by  the  weak- 
ness of  the  pulse.  When  the  actions  of  the  absorbents  of  the 
stomach  are  diminished  by  the  exhibition  of  small  doses  of  digi- 
talis, or  become  retrograde  by  larger  ones,  the  heart  and  arteries 
act  more  feebly  by  direct  sympathy;  but  the  cellular,  cutaneous 
and  pulmonary  absorbents  are  excited  into  greater  action. 
Whence  in  anasarca  the  fluids  in  the  cellular  membrane  through- 
out the  whole  body  are  absorbed  during  the  sickness,  and  fre- 
quently a great  quantity  of  atmospheric  moisture  at  the  same  time; 
as  appears  by  the  very  great  discharge  of  urine,  which  sometimes 
happens  in  these  cases;  and  in  ileus  the  prodigious  evacuations 
by  vomiting,  which  are  often  a hundred  fold  greater  than  the 
quantity  swallowed,  evince  the  great  action  of  all  the  other  ab- 
sorbents during  the  sickness  of  the  stomach. 

3.  But  when  the  stomach  is  rendered  permanently  sick  by 
an  emetic  drug,  as  by  digitalis,  it  is  not  probable,  that  much  ac- 
cumulation of  sensorial  power  is  soon  produced  in  this  organ; 

vul,  it.  3 Q 


483 


THEORY  OF  FEVER. 


Sit.  I.  12.  4. 


because  its  usual  quantity  of  sensorial  power  is  previously  ex- 
hausted by  the  great  stimulus  of  the  foxglove;  and  hence  it  seems 
probable,  that  the  great  accumulation  of  sensorial  power,  which 
now  causes  the  increased  action  of  the  absorbents,  is  produced 
in  consequence  of  the  inactivity  of  the  heart  and  arteries;  which 
inactivity  is  induced  by  deficient  excitement  of  the  sensorial 
power  of  association  between  those  organs  and  the  stomach,  and 
not  by  any  previous  exhaustion  of  their  natural  quantity  of  sen- 
sorial power;  whereas  in  ileus,  where  the  torpor  of  the  stomach, 
and  consequent  sickness,  is  induced  by  reverse  sympathy  with 
an  inflamed  intestine,  that  is,  by  dissevered  or  defective  associa- 
tion; the  accumulation  of  sensorial  power,  which  in  that  disease 
so  violently  actuates  the  cellular,  pulmonary,  and  cutaneous 
absorbents,  is  apparently  produced  by  the  torpor  of  the  stomach 
and  lacteals,  and  the  consequent  accumulation  of  the  sensorial 
power  of  association  in  them  owing  to  their  lessened  action  in 
sickness. 

4.  This  accounts  for  the  dry  skin  in  fevers  with  weak  pulse, 
where  the  stomach  and  the  heart  and  arteries  are  in  a torpid 
state,  and  for  the  sudden  emaciation  of  the  body;  because  the 
actions  of  the  cellular  and  cutaneous  absorbents  are  increased 
by  reverse  sympathy  with  those  of  the  stomach,  or  with  those  of 
the  heart  and  arteries;  that  is,  by  the  expenditure  of  that  sensorial 
power  of  association,  which  is  accumulated  in  consequence  of 
the  torpor  of  the  stomach  and  heart  and  arteries,  or  of  either  of 
them;  this  also  explains  the  sudden  absorption  of  the  milk  in 
puerperal  fevers;  and  contributes  along  with  the  heat  of  the 
respired  air  to  the  dryness  of  the  mucous  membrane  of  the  tongue 
and  nostrils. 

5.  Besides  the  reverse  sympathy,  with  which  the  absorbent 
vessels  of  the  stomach  and  qpper  intestines  act  in  respect  to  all 
the  other  absorbent  vessels,  as  in  the  exhibition  of  digitalis,  and 
in  ileus;  there  is  another  reverse  sympathy  exists  between  the 
capillaries,  or  secretory  vessels  of  the  stomach,  and  those  of  the 
skin.  Which  may  nevertheless  be  occasioned  by  the  accumula- 
tion of  sensorial  power  by  the  torpor  of  the  heart  and  arteries, 
which  is  induced  by  direct  sympathy  with  the  stomach;  thus 
when  the  torpor  of  the  stomach  remains  in  a fever-fit,  which 
might  otherwise  have  intermitted,  the  torpor  of  the  heart  and 
arteries  remains  also  by  direct  sympathy,  and  the  increased  cu- 
taneous capillary  action,  and  consequent  heat,  are  produced  by 
reverse  sympathy;  and  the  fever  is  thus  rendered  continual,  ow- 
ing primarily  to  the  torpor  of  the  stomach. 

6.  The  reverse  sympathy,  which  exists  between  the  capillaries 
of  the  stomach  and  the  cutaneous  capillaries,  appears  by  the 


Svr.  I. 12. 7. 


THEORY  OF  FEVER. 


483 


ehilness  of  some  people  after  dinner;  and  contrariwise  by  the 
digestion  being  strengthened,  when  the  skin  is  exposed  to  cold 
air  for  a short  time;  as  mentioned  in  Class  IV.  1.  1.4.  and  IV. 
2.  1.  1.  and  from  the  heat  and  glow  on  the  skin,  which  attends 
the  actionof  vomiting; for  though  when  sickness  first  commences, 
the  skin  is  pale  and  cold,  as  it  then  partakes  of  the  general  tor- 
por, which  induces  the  sickness;  vet  after  the  vomiting  has  con- 
tinued some  minutes,  so  that  an  accumulation  of  sensorial  power 
exists  in  the  capillaries  of  the  stomach,  and  of  the  skin,  owing 
to  their  diminished  action;  a glow  of  the  skin  succeeds,  with 
sweat,  as  well  as  with  increased  absorption. 

7.  Nevertheless  in  some  circumstances  the  stomach  and  the 
heart  and  arteries  seem  to  act  by  direct  sympathy  with  the  cu- 
taneous capillaries,  as  in  the  flushing  of  the  face  and  glow  of  the 
skin  of  some  people  after  dinner;  and  as  in  fevers  of  strong 
pulse.  In  these  cases  there  appears  to  be  an  increased  produc- 
tion of  sensorial  power,  either  of  sensation,  as  in  the  blush  of 
shame;  or  of  volition,  as  in  the  blush  of  anger;  or  of  irritation, 
as  in  the  flushed  face,  after  dinner  above  mentioned. 

This  increased  action  of  the  capillaries  of  the  skin  along  with 
the  increased  actions  of  the  stomach  and  heart  is  perhaps  to  be 
esteemed  asynchronous  increase  of  action,  ratherthan  a sympathy 
between  those  organs.  Thus  the  flushing  of  the  face  after  din- 
ner may  be  owing  to  the  secretion  of  sensorial  power  in  the  brain 
being  increased  by  the  association  of  that  organ  with  the  stomach 
in  a greater  proportion  than  the  increased  expenditure  of  it,  or 
may  be  owing  also  to  the  stimulus  of  new  chyle  received  into  the 
blood. 

8.  When  the  stomach  and  the  heart  and  arteries  are  rendered 
torpid  in  fevers,  not  only  the  cutaneous,  cellular,  and  pulmonary 
absorbents  are  excited  to  act  with  greater  energy,  but  also  their 
correspondent  capillaries  and  secerning  vessels,  or  glands,  especi- 
ally perhaps  those  of  the  skin,  are  induced  into  more  energetic 
action.  Whence  greater  heat,  a greater  secretion  of  perspirable 
matter,  and  of  mucus;  and  a greater  absorption  of  them  both, 
and  of  aerial  moisture.  These  reverse  sympathies  coincide  with 
other  animal  facts,  as  in  eruption  of  small-pox  on  the  face  and 
neck,  the  feet  become  cold,  while  the  face  and  neck  are  much 
flushed;  and  in  the  hemiplegia,  when  one  arm  and  leg  become 
disobedient  to  volition,  the  patient  is  perpetually  moving  the 
other.  Which  are  well  accounted  for  by  the  accumulation  of 
sensorial  power,  in  one  part  of  an  associated  series  of  actions, 
when  less  of  it  is  expended  by  another  part  of  it;  and  by  a defi- 
ciency of  sensorial  power  in  the  second  link  of  association,  when 
too  much  of  it  is  expended  by  the  first. 


484 


THEORY  OF  FEVER. 


Sup.  I.  12.  9. 


9.  This  doctrine  of  reverse  sympathy  enables  us  to  account 
for  that  difficult  problem,  why  in  continued  fevers  the  increased 
action  of  the  cutaneous,  cellular,  and  pulmonary  capillaries  pro- 
ceeds without  interruption  or  return  of  cold  fit;  though  perhaps, 
with  some  exacerbations  and  remissions;  and  that  during  a quar- 
ter, or  half,  or  three-quarters,  or  a whole  lunation;  while  at  the 
same  time  the  pulsations  of  the  heart  and  arteries  are  weaker 
than  natural. 

To  this  should  be  added  the  direct  sympathy,  which  exists  be- 
tween the  peristaltic  motions  of  the  fibres  of  the  stomach,  and 
the  pulsations  of  the  heart.  And  that  the  stomach  has  become 
torpid  by  the  too  great  stimulus  of  some  poisonous  or  contagious 
matter;  and  this  very  intricate  idea  of  continued  fever  with  fee- 
ble pulse  is  reduced  to  curious  simplicity. 

The  direct  sympathy  of  the  stomach  and  heart  and  arteries 
not  only  appears  from  the  stronger  and  slower  pulse  of  persons 
exhausted  by  fatigue,  after  they  have  drunk  a glass  of  wine,  and 
eaten  a few  mouthfuls;  but  appears  also  from  the  exhibition  of 
large  doses  of  digitalis;  when  the  patient  labours  under  great 
and  incessant  efforts  to  vomit,  at  the  same  time  that  the  actions 
of  the  absorbent  system  are  known  to  be  much  increased  by  the 
hasty  absorption  of  the  serous  fluid  in  anasarca,  the  pulsations  of 
the  heart  become  slow  and  intermittent  to  an  alarming  degree. 
See  Class  IV.  2.  1.17.  and  18. 

10.  It  would  assist  us  much  in  the  knowledge  and  cure  of  fe- 
vers, if  we  could  always  determine,  which  part  of  the  system 
was  primarily  affected;  and  whether  the  torpor  of  it  was  from 
previous  excess  or  defect  of  stimulus;  which  the  industry  of  fu- 
ture observers  must  discover.  Thus,  if  the  stomach  be  affected 
primarily,  and  that  by  previous  excess  of  stimulus,  as  when  cer- 
tain quantities  of  opium,  or  wine,  or  blue-vitriol,  or  arsenic,  are 
swallowed,  it  is  some  time  in  recovering  the  quantity  of  sensorial 
power  previously  exhausted  by  excess  of  stimulus,  before  any 
accumulation  of  it  can  occur.  But  if  it  be  affected  with  torpor 
secondarily,  by  sympathy  with  some  distant  part;  as  with  the 
torpid  capillaries  of  the  skin,  that  is  by  defective  excitement  of 
the  sensorial  power  of  association;  or  if  it  be  affected  by  defect 
of  stimulus  of  food  or  of  heat;  it  sooner  acquires  so  much  ac- 
cumulation of  sensorial  power,  as  to  be  enabled  to  accommodate 
itself  to  its  lessened  stimulus  by  increase  of  its  irritability. 

Thus  in  the  hemicrania  the  torpor  generally  commences  in  a 
diseased  tooth,  and  the  membranes  about  the  temple,  and  also 
those  of  the  stomach  become  torpid  by  direct  synchronus  sym- 
pathy; and  pain  of  the  head;  and  sickness  superveue;  but  no 
fever  or  quickness  of  pulse.  In  this  case  the  torpor  of  the  sto- 


Sur.  I.  12.  10, 


THEORY  OF  FEVER. 


485 


macli  is  owing  to  defect  of  the  sensorial  power  of  association, 
which  is  caused  by  the  too  feeble  actions  of  the  membranes  sur- 
rounding the  diseased  tooth,  and  thus  the  train  of  sympathy  ceases 
here  without  affecting  the  motions  of  the  heart  and  arteries;  but 
where  contagious  matter  is  swallowed  into  the  stomach,  the  sto- 
mach after  a time  becomes  torpid  from  exhaustion  of  the  sen- 
sorial power  of  irritation,  and  the  heart  and  arteries  act  feebly 
from  defect  of  the  excitement  of  the  power  of  association.  In 
the  former  case  the  torpor  of  the  stomach  is  conquered  by  accu- 
mulation of  the  power  of  association  in  one  or  two  whole  days; 
in  the  latter  it  recovers  by  accumulation  of  the  power  of  irrita- 
tion in  three  or  four  weeks. 

In  intermittent  fevers  the  stomach  is  generally  I believe  af- 
fected secondarily  by  sympathy  vvith  the  torpid  cutaneous  ca- 
pillaries, or  with  some  internal  torpid  viscus,  and  on  this  ac- 
count an  accumulation  of  sensorial  power  arises  in  a few  hours 
sufficient  to  restore  the  natural  irritability  of  this  organ;  and 
hence  the  hot  fit  succeeds,  and  the  fever  intermits.  Or  if  this 
accumulation  of  sensorial  power  becomes  excessive  and  perma- 
nent, the  continued  fever  with  strong  pulse  is  produced,  or  febris 
irritativa. 

In  continued  fevers  the  stomach  is  frequently  I suppose  af- 
fected with  torpor  by  previous  excess  of  stimulus,  and  conse- 
quent exhaustion  of  sensorial  power,  as  when  contagious  matter 
is  swallowed  with  the  saliva,  and  it  is  then  much  slower  in  pro- 
ducing an  accumulation  of  sensorial  power  sufficient  to  restore  its 
healthy  irritability;  which  is  a frequent  cause  of  continued  fe- 
ver with  weak  pulse  or  febris  inirritativa.  Which  consists,  after 
the  cold  fit  is  over,  in  a more  frequent  and  more  feeble  action 
of  the  heart  and  arteries,  owing  to  their  direct  sympathy  with 
the  muscular  fibres  of  the  torpid  stomach;  together  with  an  in- 
creased action  of  the  capillaries,  glands,  and  absorbents  of  the 
skin,  and  cellular  membrane,  owing  to  their  reverse  sympathy 
with  the  torpid  capillaries,  glands,  and  absorbents  of  the  stomach, 
or  with  those  of  the  heart  and  arteries. 

Or  in  more  accurate  language.  1.  The  febris  inirritativa,  or 
fever  with  weak  pulse,  commences  with  torpor  of  the  stomach, 
occasioned  by  previous  exhaustion  of  sensorial  powder  of  irrita- 
tion by  the  stimulus  of  contagious  matter  sivallowed  with  the 
saliva.  2.  The  whole  system  becomes  torpid  from  defect  of 
the  excitement  of  the  sensorial  power  of  association  owing  to 
the  too  feeble  actions  of  the  stomach,  this  is  the  cold  fit.  3.  The 
whole  system,  except  the  stomach  with  the  upper  intestines,  and 
the  heart  and  arteries,  falls  into  increased  action,  or  orgasm, 
owing  to  accumulation  of  sensorial  power  of  association  during 


486 


THEORY  OF  FEVER. 


Sup.  I.  12.  11. 


their  previous  torpor,  this  is  the  hot  fit.  4.  The  stomach  and 
upper  intestines  have  not  acquired  their  natural  quantity  of  sen- 
sorial power  of  irritation,  which  was  previously  exhausted  by 
violent  action  in  consequence  of  the  stimulus  of  contagious  mat- 
ter, and  the  heart  and  arteries  remain  torpid  from  deficient  ex- 
citement of  the  sensorial  power  of  association,  owing  to  the  too 
feeble  actions  of  the  stomach.  5.  The  accumulation  of  senso- 
rial power  of  association  in  consequence  of  the  torpor  of  the 
heart  and  arteries  occasions  a perpetual  orgasm,  or  increased  ac- 
tion of  the  capillaries. 

] 1.  From  hence  it  may  be  deducted  first,  that  when  the  tor- 
por of  the  stomach  first  occurs,  either  as  a primary  effect,  or  as 
a secondary  link  of  some  associate  train  or  circle  of  motions,  a 
general  torpor  of  the  system  sometimes  accompanies  it,  which 
constitutes  the  cold  fit  of  fever;  at  other  times  no  such  general 
torpor  occurs,  as  during  the  operation  of  a weak  emetic,  or  dur- 
ing sea  sickness. 

Secondly.  After  a time  it  generally  happens,  that  a torpor 
of  the  stomach  ceases,  and  its  actions  are  renewed  with  increase 
of  vigour  by  accumulation  of  sensorial  power  during  its  quies- 
cence; as  after  the  operation  of  a weak  emetic,  or  at  the  inter- 
vals of  sea-sickness,  or  after  the  paroxysm  of  an  intermittent 
fever. 

Thirdly.  The  stomach  is  sometimes  much  slower  in  recover- 
ing from  a previous  torpor,  and  is  then  the  remote  cause  of 
continued  fever  with  weak  pulse;  which  is  owing  to  a torpor 
of  the  heart  and  arteries,  produced  in  consequence  of  the  defi- 
cient excitement  of  the  power  of  association  by  the  too  weak 
actions  of  the  stomach;  and  to  an  orgasm  of  the  capillaries  of 
the  other  parts  of  the  system,  in  consequence  of  the  accumula- 
tion of  sensorial  power  occasioned  by  the  inactivity  of  the  heart 
and  arteries. 

Fourthly.  The  torpor  of  the  stomach  is  sometimes  so  com- 
plete, that  probably  the  origin  of  its  nerves  is  likewise  affected, 
and  then  no  accumulation  of  sensorial  power  occurs.  In  this 
case  the  patient  dies  for  want  of  nourishment:  either  in  three 
or  four  weeks,  of  the  inirritative  fever;  or  without  quick  pulse, 
by  what  we  have  called  paresis  irritativa.  Or  he  continues  ma- 
ny years  in  a state  of  total  debility.  When  this  torpor  suddenly 
commences,  the  patient  generally  suffers  epileptic  fits  or  tempo- 
rary insanity  from  the  disagreeable  sensation  of  so  great  a torpor 
of  the  stomach;  which  also  happens  sometimes  at  the  eruption 
of  the  distinct  small-pox;  whence  we  have  termed  this  disease 
anorexia  epileptica.  See  Class  II.  2.  2.  1.  and  III.  1.  1.  7.  and 
Suppl.  I.  14.  3. 


Sup.  I.  12.  11. 


THEORY  OP  FEVER. 


487- 


Fiftlily.  When  this  torpor  of  the  stomach  is  less  in  degree 
or  extent,  and  yet  without  recovering  its  natural  irritability  by 
accumulation  of  sensorial  power,  as  it  does  after  the  cold  fit 
of  intermittent  fever,  or  after  the  operation  of  mild  emetics,  or 
during  syncope;  a permanent  defect  of  its  activity  and  of  that 
of  the  upper  intestines,  remains,  which  constitutes  apepsia,  car- 
dialgia,  hypochondriasis,  and  hysteria.  See  Class  I.  3.  1.  3. 
and  I.  2.  4.  5. 

Sixthly.  If  the  torpor  of  the  stomach  be  induced  by  direct 
sympathy,  as  in  consequence  of  a previous  torpor  of  the  liver,  or 
spleen,  or  skin,  an  accumulation  of  sensorial  power  will  sooner 
be  produced  in  the  stomach;  because  there  has  been  no  previous 
expenditure  of  it,  the  present  torpor  of  the  stomach  arising 
from  defect  of  association.  Hence  some  fevers  perfectly  inter- 
mit, the  stomach  recovering  its  complete  action  after  the  torpor 
and  consequent  orgasm,  which  constitute  the  paroxysm  of  fever, 
are  terminated. 

Seventhly.  If  the  torpor  of  the  stomach  be  owing  to  defect  of 
irritation,  as  to  the  want  of  food,  an  accumulation  of  sensorial 
power  soon  occurs  with  an  increase  of  digestion,  if  food  be 
timely  applied;  or  with  violent  inflammation,  if  food  be  given 
in  too  great  quantity  after  a very  long  abstinence. 

Eighthly.  If  the  torpor  of  the  stomach  be  induced  by  defect 
of  pleasurable  sensation,  as  when  sickness  is  caused  by  the  sug- 
gestion of  nauseous  ideas;  an  accumulation  of  sensorial  power 
soon  occurs,  and  the  sickness  ceases  with  the  return  of  hunger; 
for  in  this  case  the  inactivity  of  the  stomach  is  occasioned  by  the 
subduction  of  agreeable  sensation,  which  acts  as  a subduction  of 
stimulus,  and  not  by  exhausting  the  natural  quantity  of  sensorial 
power  in  the  fibres  or  nerves  of  the  stomach. 

Ninthly.  If  the  torpor  of  the  stomach  be  induced  by  a two- 
fold cause,  as  in  sea-sickness.  See  vertigo  rotatoria.  Class  IV. 
2.  1.  10.  in  which  the  first  link  of  association  acts  too  strongly, 
and  in  consequence  expends  more  than  usual  of  the  sensorial 
power  of  irritation;  and  secondly  in  which  sensation  is  produced 
between  the  links  of  association,  and  dissevers  or  enfeebles  them; 
the  accumulation  of  sensorial  power  soon  occurs  in  the  stomach; 
as  no  previous  expenditure  of  it  in  that  organ  has  occurred. 
Whence  in  sea-sickness  the  persons  take  food  with  eagerness 
at  times,  when  the  vertigo  ceases  for  a few  minutes. 

Tenthly.  If  the  gastric  torpor  be  induced  by  previous  vio- 
lent exertion,  as  after  intoxication,  or  after  contagious  matter 
has  been  swallowed,  or  some  poisons,  as  digitalis  or  arsenic: 
an  accumulation  of  sensorial  power  very  slowly  succeeds; 


488 


THEORY  OF  FEVER. 


See.  I.  12.  12'. 


whence  long  sickness,  or  continued  fever,  because  the  quantity 
of  sensorial  power  already  wasted  must  first  be  renewed,  before 
an  accumulation  of  it  can  be  produced. 

12.  This  leads  us  to  a second  indication  of  cure  in  continued 
fevers,  which  consists  in  strengthening  the  actions  of  the  stomach; 
as  the  first  indication  consisted  in  decreasing  the  actions  of  the 
cutaneous  capillaries  and  absorbents.  The  actions  of  the  sto- 
mach may  sometimes  be  increased  by  exhibiting  a mild  emetic; 
as  an  accumulation  of  sensorial  power  in  the  fibres  of  the  stomach 
is  produced  during  their  retrograde  actions.  Besides  the  evacua- 
tion of  any  noxious  material  from  the  stomach,  and  duodenum, 
and  from  the  absorbents,  which  open  their  mouths  on  their  in- 
ternal surfaces,  by  their  retrograde  motion. 

It  is  probable,  that  when  mild  emetics  are  given,  as  ipecacu- 
anha, or  antimonium  tartarizatum,  or  infusion  of  camomile, 
they  are  rejected  by  an  inverted  motion  of  the  stomach  and 
(Esophagus  in  consequence  of  disagreeable  sensation,  as  dust  is 
excluded  from  the  eye;  and  these  actions  having  by  previous 
habit  been  found  effectual,  and  that  hence  there  is  no  exhaustion 
of  the  sensorial  power  of  irritation.  But  where  strong  emetics 
are  administered,  as  digitalis,  or  contagious  matter,  the  previous 
exhaustion  of  the  sensorial  power  of  irritation  seems  to  be  a 
cause  of  the  continued  retrograde  actions  and  sickness  of  the 
stomach.  An  emetic  of  the  former  kind  may  therefore  strength- 
en the  power  of  the  stomach  immediately  after  its  operation  by 
the  accumulation  of  sensorial  power  of  irritation  during  its  ac- 
tion. See  Class  IV.  1.1. 

Another  method  of  decreasing  the  action  of  the  stomach  for  a 
time,  and  thence  of  increasing  it  afterwards,  is  by  the  accumu- 
lation of  the  sensorial  power  of  irritation  during  its  torpor;  is  by 
giving. ice,  iced  water,  iced  creams,  or  iced  w'ine.  This  ac- 
counts for  the  pleasure,  which  many  people  in  fevers  with  weak 
pulse  express  on  drinking  cold  beverage  of  any  kind. 

A second  method  of  exciting  the  stomach  into  action,  and  of 
decreasing  that  of  the  capillaries  in  consequence,  is  by  the  stimu- 
lus of  wine,  opium,  bark,  metallic  salts  of  antimony,  steel,  cop- 
per, arsenic,  given  in  small  repeated  quantities;  which  so  long 
as  they  render  the  pulse  slower  are  certainly  of  service,  and  may 
be  given  warm  or  cold,  as  most  agreeable  to  the  patient.  For  it 
is  possible  that  the  capillaries  of  the  stomach  may  act  too  vio- 
lently, and  produce  heat,  at  the  same  time  that  the  large  muscles 
of  it  may  be  in  a torpid  state;  which  curious  circumstance  fu- 
ture observations  must  determine. 

Thirdly.  Hot  fomentation  on  the  region  of  the  stomach 
might  be  of  most  essential  service  by  its  stimulus,  as  heat  pene- 


Sup.  1. 12.  12. 


THEORY  OF  FEVER. 


489 


trates  the  system  not  by  the  absorbent  vessels,  but  by  external 
influence;  whence  the  use  of  hot  fomentation  to  the  head  in  tor- 
por of  the  brain;  and  the  use  of  hot  bath  in  cases  of  general  de- 
bility, which  has  been  much  too  frequently  neglected  from  a popu- 
lar error  occasioned  by  the  unmeaning  application  of  the  word 
relaxation  to  animal  power.  If  the  fluid  of  heat  could  be  di- 
rected to  pass  through  particular  parts  of  the  body  with  as  lit- 
tle diffusion  of  its  influence,  as  that  of  electricity  in  the  shocks 
from  the  coated  jar,  it  might  be  employed  with  still  greater  ad- 
vantage. 

Fourthly.  The  use  of  repeated  small  electric  shocks  through 
the  region  of  the  stomach  might  be  of  service  in  fevers  with 
weak  pulse,  and  well  deserves  a trial;  twenty  or  thirty  small 
shocks  twice  a day  for  a week  or  two,  would  be  a promising  ex- 
periment. 

Fifthly.  A blister  on  the  back,  or  sides,  or  on  the  pit  of  the 
stomach,  repeated  in  succession,  by  stimulating  the  skin  frequent- 
ly strengthens  the  action  of  the  stomach  by  exciting  the  senso  - 
rial power  of  association;  this,  especially  in  those  fevers  where 
the  skin  of  the  extremities,  as  of  the  hands  or  nose  or  ears,  sooner 
becomes  cold,  when  exposed  to  the  air,  than  usual. 

Sixthly.  The  action  of  the  stomach  may  be  increased  by  pre- 
venting too  great  expenditure  of  sensorial  power  in  the  link 
of  previous  motion  with  which  it  is  catenated,  especially  if  the 
action  of  that  link  be  greater  than  natural.  Thus  as  the 
capillaries  of  the  skin  act  too  violently  in  fevers  with  weak 
pulse,  if  these  are  exposed  to  cold  air  or  cold  water,  the  sensorial 
power,  which  previously  occasioned  their  orgasm,  becomes 
accumulated,  and  tends  to  increase  the  action  of  the  stomach; 
thus  in  those  fevers  with  weak  pulse  and  hot  skin,  if  the  stomach 
be  stimulated  by  repeated  small  doses  of  bark  and  wine  or  opium, 
and  be  further  excited  at  the  same  time  by  accumulation  of 
sensorial  power  occasioned  by  rendering  the  capillaries  torpid  by 
cold  air  or  water,  this  twofold  application  is  frequently  attended 
with  visible  good  effect. 

By  thus  stimulating  the  torpid  stomach  into  greater  action, 
the  motions  of  the  heart  and  arteries  will  likewise  be  increased 
by  the  greater  excitement  of  the  power  of  association.  And  the 
capillaries  of  the  skin  will  cease  to  act  so  violently,  from  their 
not  possessing  so  great  a superfluity  of  sensorial  power  as  during 
the  greater  quiescence  of  the  stomach  and  of  the  heart  and  arte- 
ries. Which  is  in  some  circumstances  similar  to  the  curious 
phenomenon  mentioned  in  Class  IV.  2.  2.  10;  where,  by  cover- 
ing the  chill  feet  with  flannel  at  the  eruption  of  the  small-pox, 
the  points  of  the  flannel  stimulate  the  skin  of  the  feet  into  greater 

vor,.  ii.  3 r 


490 


THEORY  OF  FEVER. 


Scp.  1. 13. 


action,  and  the  quantity  of  heat,  which  they  possess,  is  also  con- 
fined, or  insulated,  and  further  increases  by  its  stimulus  the  ac- 
tivity of  the  cutaneous  vessels  of  the  feet;  and  by  that  circum- 
stance abates  the  too  great  action  of  the  capillaries  of  the  face, 
and  the  consequent  heat  of  it. 

XIII.  Case  of  Continued  Fever. 

The  following  case  of  continued  fever  which  I frequently  saw 
during  its  progress,  as  it  is  less  complicate  than  usual,  may  illus- 
trate this  doctrine.  Master  S.  D.  an  active  boy  about  eight  years 
of  age,  had  been  much  in  the  snow  for  many  days,  and  sat  in  the 
classical  school  with  wet  feet;  he  had  also  about  a fortnight  at- 
tended a writing  school,  where  many  children  of  the  lower  order 
W'ere  instructed.  He  was  seized  on  February  the  8th,  1795, 
with  great  languor,  and  pain  in  his  forehead,  with  vomiting  and 
perpetual  sickness;  his  pulse  weak,  but  not  very  frequent.  He 
took  an  emetic,  and  on  the  next  day  had  a blister,  which  check- 
ed the  sickness  only  for  a few  hours;  his  skin  became  perpetu- 
ally hot  and  dry;  and  his  tongue  white  and  furred;  his  pulse 
when  asleep  about  104  in  a minute,  and  when  awake  about 
112. 

Fourth  day  of  the  disease.  He  has  had  another  blister,  the 
pain  of  his  head  is  gone,  but  the  sickness  continues  by  intervals: 
he  refuses  to  take  any  solid  food,  and  will  drink  nothing  but  milk, 
or  rajlk  and  water,  cold.  He  has  two  or  three  very  liquid  stools 
every  day,  which  are  sometimes  green,  but  generally  of  a dark- 
ish yellow,  with  great  flatulency  both  upwards  and  downwards 
at  those  times.  An  antimonial  powder  was  once  given,  but  in- 
stantly rejected;  a spoonful  of  decoction  of  bark  was  also  ex- 
hibited with  the  same  event.  His  legs  are  bathed,  and  his 
hands  and  face  are  moistened  twice  a day  for  half  an  hour  in 
warmish  water,  which  is  nevertheless  much  colder  than  his 
skin. 

Eighth  day.  His  skin  continues  hot  and  dry  without  any  ob- 
servable remissions,  with  liquid  stools  and  much  flatulency  and 
sickness;  his  water  when  observed  was  of  a straw  colour.  He 
has  asked  for  cider,  and  drinks  nearly  a bottle  a day  mixed 
with  cold  water,  and  takes  three  drops  of  laudanum  twice  a 
day. 

Twelfth  day.  He  continues  much  the  same,  takes  no  milk, 
drinks  only  cider  and  water,  skin  hot  and  dry,  tongue  hot  and 
furred,  with  liquid  stools,  and  sickness  always  at  the  same  time; 
sleeps  much. 

Sixteenth  day.  Was  apparently  more  torpid,  and  once  rather 


Sup.  L 13. 


THEORY  OF  FEVER. 


491 


delirious;  pulse  112.  Takes  only  capillaire  and  water;  sleeps 
much. 

Twentieth  day.  Pulse  100.  skin  dry  but  less  hot,  liquid  stools 
not  so  frequent,  he  is  emaciated  to  a great  degree,  he  has  eaten 
half  a tea-cupful  of  custard  to  day,  drinks  only  capillaire  and 
water,  has  thrice  taken  two  large  spoonfuls  of  decoction  of  bark 
with  three  drops  of  laudanum,  refuses  to  have  his  legs  bathed, 
and  will  now  take  nothing  but  three  drops  of  laudanum  twice  a 
day. 

Twenty-fourth  day.  He  has  gradually  taken  more  custard 
every  day,  and  began  to  attend  to  some  new  playthings,  and  takes 
wine  syllabub. 

Twenty-eighth  day.  He  daily  grows  stronger,  eats  eggs, 
and  bread  and  butter,  and  sleeps  immediately  after  his  food,  can 
creep  on  his  hands  and  knees,  but  cannot  stand  erect. 

Thirty-second  day.  He  cannot  yet  stand  alone  safely,  but 
seems  hourly  to  improve  in  strength  of  body,  and  activity  of 
mind. 

In  this  case  the  remote  cause  of  bis  fever  could  not  be  well 
ascertained,  as  it  might  be  from  having  his  feet  cold  for  many 
successive  days,  or  from  contagion;  but  the  latter  seems  more 
probable,  because  his  younger  brother  became  ill  of  a similar  fe- 
ver about  three  weeks  afterwards,  and  probably  received  the  in- 
fection from  him.  The  disease  commenced  with  great  torpor 
of  the  stomach,  which  was  shewn  by  his  total  aversion  to  solid 
food,  and  perpetual  sickness;  the  watery  stools,  which  were 
sometimes  green,  or  of  a darkish  yellow,  were  owing  to  the  acri- 
mony, or  acidity  of  the  contents  of  the  bowels;  which  as  well 
as  the  flatulency  were  occasioned  by  indigestion.  This  torpor 
of  the  stomach  continued  throughout  the  whole  fever,  and  when 
it  ceased,  the  fever  ceased  along  with  it. 

The  contagious  material  of  this  fever  I suppose  to  have  been 
mixed  with  the  saliva,  and  swallowed  into  the  stomach;  that 
it  excited  the  vessels,  which  constitute  the  stomach,  into  the 
greatest  irritative  motion  like  arsenic;  which  might  not  be  per- 
ceived, and  yet  might  render  that  organ  paralytic  or  inirritable  in  a 
moment  of  time;  as  animals  sometimes  die  by  one  single  exertion, 
and  consequent  paralysis,  without  a second  struggle;  as  by 
lightning,  or  being  shot  through  the  back  part  of  the  brain;  of 
both  which  I have  seen  instances.  I had  once  an  opportunity 
of  inspecting  two  oxen,  a few  minutes  after  they  were  killed  by 
lightning  under  a crab-tree  on  moist  ground  in  long  grass;  and 
observed,  that  they  could  not  have  struggled,  as  the  grass  was 
not  pressed  or  bent  near  them;  I have  also  seen  two  horses  shot 
through  the  cerebellum,  who  never  once  drew  in  their  legs  after 


492 


THEORY  OF  FEVER. 


Sup.  I.  13. 


they  first  stretched  them  out,  but  died  instantaneously;  in  a simi- 
lar manner  the  lungs  seem  to  be  rendered  instantly  inanimate 
by  the  fumes  of  burning  sulphur. 

The  lungs  may  be  sometimes  primarily  affected  with  conta- 
gious matter  floating  in  the  atmosphere  as  well  as  the  stomach, 
as  mentioned  in  article  9.  of  this  Supplement.  But  probably 
this  may  occur  much  less' frequently,  because  the  oxygene  of  the 
atmosphere  does  not  appear  to  be  taken  into  the  blood  by  ani- 
mal absorption,  as  the  saliva  in  the  stomach,  but  passes  through 
the  moist  membranes  into  the  blood,  like  the  ethereal  fluids  of 
electricity  or  heat,  or  by  chemical  attraction,  and  in  consequence 
the  contagious  matter  may  be  left  behind;  except  it  may  some- 
times be  absorbed  along  with  the  mucus;  of  which  however  in 
this  case  there  appeared  no  symptoms. 

The  tonsils  or  other  organs  liable  to  receive  contagious  mat- 
ter, as  in  the  small-pox,  scarlet-fever,  and  in  other  sensitive  in- 
irritated  fevers;  but  no  symptom  of  this  appeared  here,  as  the 
tonsils  were  at  no  time  of  the  fever  inflamed,  though  they  were 
in  this  child  previously  uncommonly  large. 

The  pain  of  the  forehead  does  not  seem  to  have  been  of  the 
internal  parts  of  the  head,  because  the  nerves,  which  serve  the 
stomach,  are  not  derived  from  the  anterior  part  of  the  brain; 
but  it  seems  to  have  been  owing  to  the  torpor  of  the  external  mem- 
branes about  the  forehead  from  their  direct  sympathy  with  those 
of  the  stomach;  that  is,  from  the  deficient  excitement  of  the 
sensorial  power  of  association;  and  seemed  in  some  measure  to 
be  relieved  by  the  emetics  and  blisters. 

The  pulsations  of  the  heart  were  weaker  and  in  consequence 
quicker  than  natural,  owing  to  their  direct  sympathy  with  the 
torpid  peristaltic  motions  of  the  stomach;  that  is,  to  the  deficient 
excitement  of  the  sensorial  power  of  association. 

The  action  of  the  cutaneous  capillaries  and  absorbents  was 
stronger  than  natural,  as  appeared  by  the  perpetual  heat  and 
dryness  of  the  skin;  which  was  owing  to  their  reverse  sympathy 
with  the  heart  and  arteries.  This  weaker  and  quicker  action  of 
the  heartland  arteries,  and  the  stronger  action  of  the  cutaneous 
capillaries  and  absorbents,  continued  throughout  the  disease, 
and  may  be  said  to  have  constituted  the  fever,  of  which  the  tor- 
por of  the  stomach  was  the  remote  cause. 

His  tongue  was  not  very  much  furred  or  very  dry,  nor  his 
breath  very  hot;  which  shewed,  that  there  was  no  great  increase 
of  the  action  of  the  mucous  absorbents,  nor  of  the  pulmonary 
capillaries,  and  vet  sufficient  to  produce  great  emaciation  His 
urine  was  nearly  natural  both  in  quantity  and  colour;  which 


Sup.  I.  14.  1. 


THEORY  OF  FEVER. 


493 


shewed,  that  there  was  no  increase  of  action  either  of  the  kid- 
neys, or  of  the  urinary  absorbents. 

The  bathing  his  legs  and  hands  and  face  for  half  an  hour  twice 
a day  seemed  to  refresh  him,  and  sometimes  made  his  pulse 
slower,  and  thence  I suppose  stronger.  This  seems  to  have  been 
caused  by  the  water,  though  subtepid,  being  much  below  the 
heat  of  his  skin,  and  consequently  contributing  to  cool  the  capil- 
laries, and  by  satiating  the  absorbents  to  relieve  the  uneasy  sen- 
sation from  the  dryness  of  the  skin. 

He  continued  the  use  of  three  drops  of  tincture  of  opium 
from  about  the  eighth  day  to  the  twenty-fourth,  and  for  the 
three  preceding  days  took  along  with  it  two  large  spoonfuls  of 
an  infusion  of  bark  in  equal  parts  of  wine  and  water.  The 
former  of  these  by  its  stimulus  seemed  to  decrease  his  languor 
for  a time,  and  the  latter  to  strengthen  his  returning  power  of  di- 
gestion. 

The  daily  exacerbations  or  remissions  were  obscure,  and  not 
well  attended  to;  but  he  appeared  to  be  worse  on  the  fourteenth 
or  fifteenth  days,  as  his  pulse  was  then  quickest,  and  his  inat- 
tention greatest;  and  he  began  to  get  better  on  the  twentieth 
or  twenty-first  days  of  his  disease;  for  the  pulse  then  became 
less  frequent,  and  his  skin  cooler,  and  he  took  rather  more  food: 
these  circumstances  seemed  to  observe  the  quarter  periods  of 
lunation. 

XIY.  Termination  of  Continued  Fever. 

1 . When  the  stomach  is  primarily  affected  with  torpor  not  by 
defect  of  stimulus,  but  in  consecjuence  of  the  previous  exhaustion 
of  its  sensorial  power;  and  not  secondarily  by  its  association  with 
other  torpid  parts  ; it  seems  to  be  the  general  cause  of  the  weak 
pulsations  of  the  heart  and  arteries,  and  the  consequent  increased 
action  of  the  capillaries,  which  constitute  continued  fever  with 
weak  pulse.  In  this  situation  if  the  patient  recovers,  it  is  owing 
to  the  renovation  of  life  in  the  torpid  stomach,  as  happens  to  the 
whole  system  in  winter-sleeping  animals.  If  he  perishes,  it  is 
owing  to  the  exhaustion  of  the  body  for  want  of  nourishment  oc- 
casioned by  indigestion;  which  is  hastened  by  the  increased  ac- 
tions of  the  capillaries  and  absorbents. 

2.  When  the  stomach  is  primarily  affected  by  defect  of  stimu- 
lus, as  by  cold  or  hunger;  or  secondarily  by  defect  of  the  power 
of  association,  as  in  intermittent  fevers;  or  lastly  in  conse- 
quence of  the  introduction  of  the  sensorial  power  of  sensation, 
as  in  inflammatory  diseases;  the  actions  of  the  heart  and  arteries 
are  not  diminished,  as  when  the  stomach  is  primarily  affected 


494  THEORY  OF  FEVER.  Sir.  1.  14.  o. 

with  torpor  by  its  previous  exhaustion  of  sensorial  power,  but 
become  greatly  increased,  producing  irritative  or  inflammatory 
fever.  Where  this  fever  is  continued,  though  with  some  re- 
missions and  exacerbations,  the  excessive  action  is  at  length  so 
much  lessened  by  expenditure  of  sensorial  power,  as  to  gradually 
terminate  in  health;  or  it  becomes  totally  exhausted,  and  death 
succeeds  the  destruction  of  the  irritability  and  associability  of 
the  system. 

3.  There  is  also  another  termination  of  the  diseases  in  con- 
sequence of  great  torpor  of  the  stomach,  which  are  not  always 
termed  fevers;  one  of  these  is  attended  with  so  great  and  uni- 
versal torpor,  that  the  patient  dies  in  the  first  cold  fit;  that  is, 
within  twelve  hours  or  less  of  the  first  seizure;  this  is  commonly 
termed  sudden  death.  But  the  quickness  of  the  pulse,  and  the 
coldness  with  shuddering  and  with  sick  stomach,  distinguished 
a case,  which  I lately  saw,  from  the  sudden  deaths  occasioned  by 
apoplexy,  or  ruptured  blood-vessels. 

In  hemicrania  I believe  the  stomach  is  always  affected  secon- 
darily, as  no  quickness  of  pulse  generally  attends  it,  and  as  the 
stomach  recovers  its  activity  in  about  two  whole  days.  But  in 
the  following  case,  which  I saw  last  week,  I suppose  the  stomach 
suddenly  became  paralytic,  and  caused  in  about  a week  the 

death  of  the  patient.  Miss , a fine  young  lady  about 

nineteen,  had  bathed  a few  times,  about  a month  before,  in  a 
cold  spring,  and  was  always  much  indisposed  after  it;  she  was 
seized  with  sickness,  and  cold  shuddering,  with  very  quick  pulse, 
which  was  succeeded  by  a violent  hot  fit;  during  the  next  cold 
paroxysm  she  had  a convulsion  fit;  and  after  that  symptoms  of 
insanity,  so  as  to  strike  and  bite  the  attendants,  and  to  speak 
furious  language;  the  same  circumstances  occurred  during  a third 
fit,  in  which  I believe  a strait  waistcoat  was  put  on,  and  some 
blood  taken  from  her;  during  all  this  time  her  stomach  would 
receive  no  nutriment,  except  once  or  twice  a little  wine  and 
water.  On  the  seventh  day  of  the  disease,  when  I saw  her,  the 
extremities  were  cold,  the  pulse  not  to  be  counted,  and  she  was 
unable  to  swallow,  or  to  speak;  a clyster  was  used  with  turpen- 
tine and  musk  and  opium,  with  warm  fomentations,  but  she  did 
not  recover  from  that  cold  fit. 

In  this  case  the  convulsion  fit  and  the  insanity  seem  to  have 
been  violent  efforts  to  relieve  the  disagreeable  sensation  of  the 
paralytic  stomach;  and  the  quick  pulse,  and  returning  fits  of 
torpor  and  of  orgasm,  evinced  the  disease  to  be  attended  with 
fever,  though  it  might  have  been  called  anorexia  maniacalis,  or 
epileptica. 

4.  Might  not  many  be  saved  in  these  fevers  with  weak  pulse 


Sup.  I.  15. 1. 


THEORY  OF  FEVER. 


495 


for  a few  weeks  by  the  introduction  of  blood  into  a vein,  once  in 
two  or  three  days;  which  might  thus  give  further  time  for  the 
recovery  of  the  torpid  stomach?  Which  seems  to  require  some 
weeks  to  acquire  its  former  habits  of  action,  like  the  muscles  of 
paralytic  patients,  who  have  all  their  habits  of  voluntary  associa- 
tions to  form  afresh,  as  in  infancy. 

If  this  experiment  be  again  tried  on  the  human  subject,  it 
should  be  so  contrived,  that  the  blood  in  passing  from  the  well 
person  to  the  sick  one  should  not  be  exposed  to  the  air;  it  should 
not  be  cooled  or  heated;  and  it  should  be  measured;  all  which 
may  be  done  in  the  following  manner.  Procure  two  silver  pipes, 
each  about  an  inch  long,  in  the  form  of  funnels,  wide  at  top, 
with  a tail  beneath,  the  former  something  wider  than  a swan- 
quill,  and  the  latter  less  than  a small  crow-quill.  Fix  one  of 
these  silver  funnels  by  its  wide  end  to  one  end  of  the  gut  of  a 
chicken  fresh  killed  about  four  or  six  inches  long,  and  the  other 
to  the  other  end  of  the  gut;  then  introduce  the  small  end  of  one 
funnel  into  the  vein  of  the  arm  of  a well  person  downwards  to- 
wards the  hand;  and  laying  the  gut  with  the  other  end  on  a 
water-plate  heated  to  98  degrees  in  a very  warm  room,  let  the 
blood  run  through  it.  Then  pressing  the  finger  on  the  gut  near 
the  arm  of  the  well  person,  slide  it  along  so  as  to  press  out  one 
gutful  into  a cup,  in  order  to  ascertain  the  quantity  by  weight. 
Then  introduce  the  other  end  of  the  other  funnei  into  a similar 
vein  in  the  arm  of  the  sick  person  upwards  towards  the  shoul- 
der; and  by  sliding  one  finger,  and  then  another  reciprocally, 
along  the  chicken’s  gut,  so  as  to  compress  it,  from  the  arm  of 
the  well  person  to  the  arm  of  the  sick  one,  the  blood  may  be 
measured,  and  thus  the  exact  quantity  known  which  is  given 
and  received.  See  Class  I.  2.  3.  25. 

XV.  Inflammation  excited  in  Fever. 

1.  When  the  actions  of  any  part  of  the  system  of  capillaries 
are  excited  to  a certain  degree,  sensation  is  produced,  along 
with  a greater  quantity  of  heat,  as  mentioned  in  the  fifth  article 
of  this  supplement.  When  this  increased  capillary  action  be- 
comes still  more  energetic,  by  the  combined  sensorial  powers  of 
sensation  with  irritation,  new  fibres  are  seereted,  or  new  fluids, 
(which  harden  into  fibres  like  the  mucus  secreted  by  the  silk- 
worm, or  spider,  or  pinna,)  from  which  new  vessels  are  con- 
structed; it  is  then  termed  inflammation:  if  this  exists  in  the  ca- 
pillary vessels  of  the  cellular  membrane  or  skin  only,  with  feeble 
pulsations  of  the  heart  and  arteries,  the  febris  sensitiva  inirri- 
tata,  or  malignant  fever,  occurs;  if  the  coats  of  the  arteries 


496 


THEORY  OF  FEVER. 


Scr.  I.  15.  2. 


are  also  inflamed,  the  febris  sensitiva  irritala,  or  inflammatory 
fever,  exists. 

In  all  these  fevers  the  part  inflamed  is  called  a phlegmon,  and 
by  its  violent  actions  excites  so  much  pain,  that  is,  so  much  of 
the  sensorial  power  of  sensation,  as  to  produce  more  violent  ac- 
tions, and  inflammation,  throughout  the  whole  system.  Whence 
great  heat  from  the  excited  capillaries  of  the  skin,  large  and 
quick  pulsations  of  the  heart,  full  and  hard  arteries,  with  great 
universal  secretions  and  absorptions.  These  perpetually  conti- 
nue, though  with  exacerbations  and  remissions;  which  seem  to 
be  governed  by  solar  or  lunar  influence. 

2.  In  this  situation  there  generally,  I suppose,  exists  an  in- 
creased activity  of  the  secerning  vessels  of  the  brain,  and  conse- 
quently an  increased  production  of  sensorial  power;  in  less  vio- 
lent quantity  of  this  disease,  however,  the  increase  of  the  action 
of  the  heart  and  arteries  may  be  ow7ing  simply  to  the  accumula- 
tion of  sensorial  power  of  association  in  the  stomach,  w hen  that 
organ  is  affected  by  sympathy  with  some  inflamed  part.  In  the 
same  manner  as  the  capillaries  are  violently  and  permanently  ac- 
tuated by  the  accumulation  of  the  sensorial  power  of  association 
in  the  heart  and  arteries,  when  the  stomach  is  affected  primarily 
bv  contagious  matter,  and  the  heart  and  arteries  secondarily. 
Thus  I suspect,  that  in  the  distinct  small-pox  the  stomach  is  af- 
fected secondarily  by  sympathy  with  the  infected  tonsils  or  ino- 
culated arm;  but  that  in  the  confluent  small-pox  the  stomach  is 
affected  primarily,  as  well  as  the  tonsils,  by  contagious  matter 
mixed  with  the  saliva,  and  swallowed. 

3.  In  inflammatory  fevers  with  great  arterial  action,  as  the 
stomach  is  not  always  affected  with  torpor,  and  as  there  is  a di- 
rect sympathy  between  the  stomach  and  heart,  some  people  have 
believed,  that  nauseating  doses  of  some  emetic  drug,  as  of  anti- 
monium  tartarizatum,  have  been  administered  with  advantage, 
abating  by  direct  sympathy  the  actions  of  the  heart.  This  theory 
is  not  ill-founded,  and  the  use  of  digitalis,  given  in  small  doses, 
as  from  half  a dram  to  a dram  of  the  saturated  tincture,  two  or 
three  times  a day,  as  well  as  other  less  violent  emetic  drugs, 
would  be  worth  the  attention  of  hospital  physicians. 

In  three  cases  of  what  I believed  to  be  inflammatory  rheu- 
matism, two  of  them  attended  with  pain  of  the  side,  and  difficult 
respiration,  and  the  other  with  swelled  joints,  after  repeated  ve- 
nesections and  moderate  cathartics,  and  mild  doses  of  aniimonials, 
w'ithout  success,  the  tincture  of  digitalis  given  in  the  small  dose 
of  ten  drops  every  six  hours,  appeared  to  abate  the  quickness 
and  hardness  of  the  pulse  in  two  or  three  or  four  days,  without 
inducing  any  degree  of  sickness. 


Sep.  1.  15.  4. 


THEORY  OF  FEVER. 


497 


Sickness  might  also  be  produced  probably  with  advantage  by 
whirling  the  patient  in  a chair  suspended  from  the  ceiling  by  two 
parallel  cords;  which  after  being  revolved  fifty  or  a hundred 
times  in  one  direction,  would  return  with  great  circular  velocity, 
and  produce  vertigo,  similar  I suppose  to  sea-sickness.  And 
lastly,  the  sickness  produced  by  respiring  an  atmosphere  mixed 
with  onh  tenth  of  carbonated  hydrogen,  discovered  by  Mr.  Watt, 
and'published  by  Dr.  Beddoes,  would  be  well  worthy  exact  and 
repeated  experiment. 

4.  Cool  air,  cool  fomentations,  or  ablutions,  are  also  useful 
in  this  inflammatory  fever;  as  by  cooling  the  particles  of  blood 
in  the  cutaneous  and  pulmonary  vessels,  they  must  return  to  the 
heart  with  less  stimulus,  than  when  they  are  heated  above  the 
natural  degree  of  ninety-eight.  For  this  purpose  snow  and  ice 
have  been  scattered  on  the  patients  in  Italy;  and  cold  bathing 
has  been  used  at  the  eruption  of  the  small-pox  in  China,  and 
both,  it  is  said,  with  advantage.  See  Class  III.  2.  1.  12.  and 
Suppl.  I.  8. 

5.  The  lancet  however  with  repeated  mild  cathartics  is  the 
great  agent  in  destroying  this  enormous  excitement  of  the  sys* 
tem,  so  long  as  the  strength  of  the  patient  will  admit  of  evacua- 
tions. Blisters  over  the  painful  part,  where  the  phlegmon  or  topi- 
cal inflammation  is  situated,  afier  great  evacuation,  is  of  evident 
service,  as  in  pleurisy.  Warm  bathing  for  half  an  hour  twice  a 
day,  when  the  patient  becomes  enfeebled,  is  of  great  benefit,  as  in 
peripneumony  and  rheumatism. 

6.  W'hen  other  means  fail  of  success  in  abating  the  violent 
excitement  of  the  system  in  inflammatory  diseases,  might  not 
the  shaved  head  be  covered  with  large  bladders  of  cold  water,  in 
which  ice  or  salt  had  been  recently  dissolved;  and  changed  as 
often  as  necessary,  till  the  brain  is  rendered  in  some  degree  tor- 
pid by  cold? — Might  not  a greater  degree  of  cold,  as  iced  water, 
or  snow,  be  applied  to  the  cutaneous  capillaries? 

7.  Another  experiment  I have  frequently  wished  to  try,  which 
cannot  be  done  in  private  practice,  and  which  I therefore  re- 
commend to  some  hospital  physician;  and  that  is,  to  endeavour 
to  still  the  violent  actions  of  the  heart  and  arteries,  after  due 
evacuations  by  venesection  and  cathartics,  by  gently  compressing 
the  brain.  This  might  be  done  by  suspending  a hed,  so  as  to 
whirl  the  patient  round  with  his  head  most  distant  from  the  cen- 
tre of  motion,  as  if  he  lay  across  a mill-stone,  as  described  in 
Sect.  XVIII.  20.  For  this  purpose  a perpendicular  shaft  armed 
with  iron  gudgeons  might  have  one  end  passed  into  the  floor,  and 
the  other  into  a beam  in  the  ceiling,  with  an  horizontal  arm, 
to  which  a small  bed  might  be  readily  suspended. 

VOL.  it.  3 s 


498 


THEORY  OF  FEVER. 


Sup.  I.  16.  1. 


By  thus  whirling  the  patient  with  increasing  velocity  sleep 
might  be  produced,  and  probably  the  violence  of  the  actions  of 
the  heart  and  arteries  might  be  diminished  in  inflammatory  fevers; 
and,  as  it  is  believed,  that  no  accumulation  of  sensorial  power 
would  succeed  a torpor  of  the  origin  of  the  nerves,  either  thus  pro- 
cured by  mechanical  compression,  or  by  the  bladder-cap  of  cold 
water  above  described,  the  lives  of  thousands  might  probably  be 
saved  by  thus  extinguishing  the  exacerbations  of  febrile  pa- 
roxysms, or  preventing  the  returns  of  them. 

In  fevers  with  weak  pulse,  sleep,  or  a degree  of  stupor,  thus 
produced,  might  prevent  the  too  great  expenditure  of  sensorial 
power,  and  thus  continue  to  preserve  the  patient.  See  Class  I. 
2.  5.  10.  on  stupor.  What  might  be  the  consequence  of  whirl- 
ing a person  with  his  head  next  the  centre  of  motion,  so  as  to 
force  the  blood  from  the  brain  into  the  other  parts  of  the  body, 
might  be  discovered  by  cautious  experiment  without  danger,  and 
might  probably  add  to  our  ability  of  curing  fever. 

Mr.  Kelly,  in  his  Observations  on  Compression,  Edinb  1797, 
asserts,  that  by  compressing  the  two  subclavian  arteries,  as  they 
pass  over  the  first  rib,  more  blood  will  compress  the  brain,  and 
produce  a kind  of  apoplectic  state,  similar  to  that  which  may 
occur  by  the  centrifugal  force,  if  the  patient  was  whirled  round 
as  above  described.  And  adds,  that  by  this  compression  of  the 
two  subclavian  arteries  a greater  quantity  of  blood  w ill  be  circu- 
lated through  the  head,  whence  the  patient  soon  complains  of 
drowsiness  and  vertigo;  and  that  hence  different  species  of 
head-achs  are  soon  removed,  especially  those  which  depend  on 
defect  of  stimulation. 

XVI.  Recapitulation. 

1.  The  sensorial  powder  causes  the  contraction  of  the  fibres, 
and  is  excited  into  action  by  four  different  circumstances,  by  the 
stimulus  of  external  bodies,  by  pain  or  pleasure,  by  desire  or 
aversion,  or  by  the  previous  motions  of  other  contracting  fibres. 
In  the  first  situation  it  is  called  the  sensorial  power  of  irritation, 
in  the  second  the  sensorial  power  of  sensation,  in  the  third  the 
sensorial  power  of  volition,  and  in  the  fourth  the  sensorial  power 
of  association. 

Many  parts  of  the  body  are  excited  into  perpetual  action,  as 
the  sanguiferous  vessels,  consisting  of  the  heart,  arteries,  and 
veins;  others  into  nearly  perpetual  action,  as  the  conglomerate 
and  capillary  glands;  and  others  into  actions  still  somewhat 
less  frequent,  as  the  alimentary  canal,  and  the  lacteal  and 
lymphatic  absorbents  with  their  conglobate  glands;  all  these  are 


Sup.  I.  16.  2. 


THEORY  OP  FEVER. 


499 


principally  actuated  by  the  sensorial  powers  of  irritation,  and  of 
association;  but  in  some  degree  or  at  some  times  by  those  of  sen- 
sation, and  even  of  volition.  There  are  three  kinds  of  stimulus, 
which  may  easily  be  occasionally  diminished,  that  of  heat  on  the 
skin,  of  food  in  the  stomach,  and  of  the  oxygenous  part  of  the  at- 
mosphere, which  mixes  with  the  blood  in  respiration,  and  stimu- 
lates the  heart  and  arteries. 

2.  When  any  parts,  which  are  naturally  excited  into  perpetual 
action  by  stimulus,  become  torpid  or  less  active  from  decrease  of 
that  stimulus;  there  first  occurs  a decrease  of  the  activity  of  the 
parts  next  catenated  with  them;  thus,  going  into  cold  wrater  pro- 
duces a torpor  of  the  capillary  vessels  of  the  lungs,  as  is  known 
by  the  difficult  respiration  which  immediately  occurs;  for,  the 
sensorial  power  of  association,  which  naturally  contributes  to  ac- 
tuate the  lungs,  is  now  less  excited  by  the  decreased  actions  of 
the  cutaneous  vessels,  with  which  they  are  catenated.  This  con- 
stitutes the  cold  fit  of  fever. 

There  next  occurs  an  accumulation  of  the  sensorial  power  of 
irritation  in  the  parts,  which  were  torpid  from  defect  of  stimulus, 
as  the  cutaneous  vessels  for  instance,  when  exposed  to  cold  air; 
and  a similar  accumulation  of  the  sensorial  power  of  association 
occurs  in  the  parts  which  were  catenated  with  the  former,  as  the 
vessels  of  the  lungs,  in  the  example  above  mentioned.  Whence 
if  the  subduction  of  stimulus  has  not  been  too  great,  so  as  to  im- 
pair the  health  of  the  part,  the  activity  of  the  irritative  motions 
returns,  even  though  the  stimulus  continues  less  than  usual;  and 
those  of  the  associate  motions  become  considerably  increased, 
because  these  latter  are  now  excited  by  the  previous  fibrous  mo- 
tions, which  now  act  as  strong  or  stronger  than  formerly,  and  have 
also  acquired  an  accumulation  of  the  sensorial  power  of  associ- 
ation. This  accounts  for  the  curious  event  of  our  becoming 
W'arm  in  a minute  or  two  after  remaining  in  water  of  about  80 
degrees  of  heat,  as  in  the  bath  at  Buxton;  or  in  the  cold  air  of  a 
frosty  morning  of  about  30  degrees  of  heat. 

But  if  the  parts  thus  possessed  of  the  accumulated  sensorial 
powers  of  irritation  and  of  association,  be  exposed  again  to  their 
natural  quantity  of  stimulus,  a great  excess  of  activity  supervenes; 
because  the  fibres,  which  possess  accumulated  irritation,  are  now 
excited  by  their  usual  quantity  of  stimulus;  and  those  which  pos- 
sess accumulated  association,  are  now  excited  by  double  or  treble 
the  quantity  of  the  preceding  irritative  fibrous  motions,  with 
which  they  are  catenated;  this  constitutes  the  hot  fit  of  fever. 

Another  important  circumstance  occurs,  when  the  parts  which 
arc  torpid  from  decreased  stimulus,  do  not  accumulate  a quantity 


500 


THEORY  OF  FEVER. 


Scp. I.  16.  3. 


of  sensorial  power  sufficient  for  the  purpose  of  renewing  their  own 
natural  quantity  of  action;  but  are  nevertheless  not  so  torpid,  as 
to  have  the  life  of  the  part  impaired.  In  this  situation,  the  su- 
perabundance of  the  accumulated  power  of  irritation  contributes 
to  actuate  the  associate  motions  next  catenated  with  them.  Thus, 
when  a person  breathes  air  with  less  oxygene  than  natural,  as  by 
covering  his  head  in  bed,  and  thus  respiring  the  same  atmosphere 
repeatedly,  the  heart  and  arteries  become  less  active  by  defect  of 
the  stimulus  of  oxygene;  and  then  the  accumulation  of  senso- 
rial power  of  irritation  becomes  instantly  very  great,  as  these  or- 
gans are  subject  to  perpetual  and  energetic  action.  This  accu- 
mulation, nevertheless,  is  not  so  great  as  to  renew  their  own  ac- 
tivity under  this  defect  of  stimulus,  but  yet  is  in  sufficient  abun- 
dance to  increase  the  associabilily  of  the  next  link  of  catenation, 
that  is,  to  actuate  the  capillaries  of  the  skin  with  great  and  per- 
petual increase  of  energy.  This  resembles  continued  fever,  with 
weak  pulse;  in  which  the  accumulation  of  the  sensorial  power 
caused  by  the  lessened  motions  of  the  heart  and  arteries,  actuates 
the  capillaries  with  increase  of  energy. 

3.  When  the  accumulation  of  the  sensorial  power  of  associ- 
ation, which  is  caused,  as  above  explained,  by  deficient  excite- 
ment, owing  to  the  lessened  quantity  of  action  of  the  irritative 
fibrous  motions,  with  which  the  associate  train  is  catenated,  is 
not  in  quantity  sufficient  to  renew  the  natural  actions  of  the  first 
link  of  an  associate  train  of  motions;  it  is  nevertheless  fre- 
quently so  abundant  as  to  actuate  the  next  link  of  the  associated 
train  with  unnatural  energy,  by  increasing  its  associability ; and 
that  in  a still  greater  degree,  if  that  second  link  of  the  associated 
train  was  previously  in  a torpid  state,  that  is,  had  previously  ac- 
quired some  accumulation  of  the  sensorial  power  of  association. 
This  important  circumstance  of  the  animal  economy  is  worthy 
our  most  accurate  attention.  Thus  if  the  heart  and  arteries  are 
deprived  of  their  due  quantity  of  the  stimulus  of  oxygene  in  the 
blood,  a weak  and  quick  pulse  ensues,  with  an  accumulation  of 
the  sensorial  power  of  irritation;  next  follows  an  increase  of  the 
action  of  the  capillaries  by  the  superabundance  of  this  accumu- 
lated power  of  irritation;  but  there  also  exists  an  accumulation 
of  the  power  of  association  in  these  acting  capillaries,  which  is 
not  now  excited  by  the  deficient  actions  of  the  heart  and  arte- 
ries; but  which,  by  its  abundance,  contributes  to  actuate  the 
next  link  of  association,  which  is  the  sick  stomach  in  the  case 
related  from  Sydenham  in  Class  IV.  1.  1.2.  and  explained  in 
this  Supplement  I.  4.  And  as  this  sick  stomach  was  in  a pre- 
vious slate  of  torpor,  it  might  at  the  same  time  possess  an  accu- 
mulation of  some  sensorial  potver,  which,  if  it  was  of  association, 


Sup.  I.  16.  4. 


THEORY  OF  FEVER. 


501 


would  be  thus  more  powerfully  excited  by  the  increased  actions 
of  the  capillaries;  which  existed  in  consequence  of  the  weak 
action  of  the  heart  and  arteries.  This  also  resembles  in  some 
respects  the  continued  fevers  with  weak  pulse,  and  with  increas- 
ed activity  of  the  capillaries. 

4.  When  a torpor  of  some  irritative  motions  occurs  from  a 
previous  exhaustion  of  the  sensorial  power  of  irritation  by  the 
action  of  some  very  great  stimulus,  it  is  long  before  any  accu- 
mulation of  the  sensorial  power  of  irritation  is  produced;  as  is 
experienced  in  the  sickness  and  languor,  which  continue  a whole 
day  after  a fit  of  drunkenness.  But  nevertheless  there  occurs 
an  accumulation  of  the  sensorial  power  of  association  in  the  first 
link  of  the  associate  train  of  motions,  which  is  catenated  with 
these  torpid  irritative  ones;  which  accumulation  is  owing  to  de- 
ficient excitement  of  that  sensorial  power  in  the  first  link  of  the 
associate  train.  This  first  link  therefore  exists  also  in  a less  ac- 
tive or  torpid  state,  but  the  accumulation  of  the  sensorial  power 
of  association  by  its  superabundance  contributes  to  actuate  the 
second  link  of  the  associate  train  with  unnatural  quantity  of  mo- 
tion; and  that  though  its  own  natural  quantity  of  the  power  of 
association  is  not  excited  by  the  deficient  action  of  preceding 
fibrous  motions. 

When  this  happens  to  the  stomach,  as  after  its  irritative  mo- 
tions have  been  much  exerted  from  the  unnatural  stimulus  of 
wine,  or  opium,  or  of  contagious  matter  mixed  with  the  saliva, 
a torpor  or  inactivity  of  it  succeeds  for  a greater  or  less  length 
of  time;  as  no  accumulation  of  the  sensorial  power  of  irritation 
can  occur  till  the  natural  quantity  which  has  been  previously  ex- 
pended, is  first  restored.  Then  the  heart  and  arteries,  which  are 
next  in  catenation,  become  less  active  from  the  rvant  of  suffi- 
cient excitement  of  the  sensorial  power  of  association,  which 
previously  contributed  to  actuate  them.  This  sensorial  power 
of  association  therefore  becomes  accumulated,  and  by  its  super- 
abundance contributes  to  actuate  the  link  next  in  association, 
which  has  thus  acquired  so  great  a degree  of  associability,  as  to 
overbalance  the  less  quantity  of  the  excitement  of  it  by  the  tor- 
pid action  of  the  previous  or  first  associate  link.  This  happens 
to  the  capillaries,  when  the  heart  and  arteries  are  affected  as 
above  by  the  torpor  of  the  stomach,  when  it  is  occasioned  by 
previous  great  expenditure  of  its  sensorial  powei’,  and  thus  con- 
stitutes fever  with  weak  pulse,  which  is  here  termed  inirritative 
fever,  typhus  miliar. 

5.  When  a deficiency  of  stimulus  is  too  great  or  too  long  con- 
tinued, so  as  to  impair  the  life  of  the  part,  no  further  accumu- 
lation of  sensorial  power  occurs;  as  when  the  skin  is  long  exposed 


502 


THEORY  OF  FEVER. 


Sup.  I.  16.  6. 


to  cold  and  damp  air.  In  that  case,  the  link  in  catenation,  that 
is,  the  first  of  the  associate  train,  is  rendered  torpid  by  defect  of 
excitement  of  its  usual  quantity  of  the  sensorial  power  of  asso- 
ciation, and  from  there  being  no  accumulation  of  the  sensorial 
power  of  irritation  to  increase  its  associability,  and  thus  to  con- 
tribute to  actuate  it  by  overbalancing  the  defect  of  the  excite- 
ment of  its  association. 

Thus  on  riding  long  and  slowly  on  a cold  and  damp  day, 
the  exhalation  of  the  vapour,  which  is  impinged  on  the  skin,  as 
the  traveller  proceeds,  carries  away  his  warmth  faster,  than  it  is 
generated  within  the  system;  and  thus  the  capillaries  of  the  skin 
have  their  actions  so  much  impaired  after  a time,  that  no  accu- 
mulation of  the  sensorial  power  of  irritation  occurs;  and  then 
the  stomach,  the  motions  of  which  are  catenated  with  those  of 
the  capillaries,  ceases  to  act  from  the  deficient  excitement  of  the 
power  of  association;  and  indigestion  and  flatulency  succeed, 
instead  of  the  increased  digestion  and  hunger,  which  occur, 
when  the  cutaneous  capillaries  are  exposed  to  a less  degree  of 
cold,  and  for  a shorter  time.  In  which  latter  situation  the  accu- 
mulation of  the  sensorial  power  of  irritation  increases  by  its 
superabundance  the  associability  of  the  fibres  of  the  stomach,  so 
as  to  overbalance  the  defect  of  the  excitement  of  their  associa- 
tion. 

6.  The  stomach  is  affected  secondarily  in  fevers  with  strong 
pulse,  as  in  those  with  weak  pulse  it  is  affected  primarily.  To 
illustrate  this  doctrine,  I shall  relate  the  following  case  of  Mr. 

Y . He  was  a young  man  rather  intemperate  in  the  use 

of  wine  or  beer,  and  was  seized  with  a cold  fit,  and  with  a con- 
sequent hot  one  with  strong  pulse;  on  examining  his  hypochon- 
drium,  an  oblong  tumour  was  distinctly  felt  on  the  left  side  of 
the  stomach,  which  extended  six  or  eight  inches  downward,  and 
was  believed  to  be  a tumour  of  the  spleen,  which  thus  occasioned 
by  its  torpor  the  cold  fit  and  consequent  hot  fit  of  fever  with 
strong  pulse.  This  fever  continued,  though  with  remissions, 
for  two  or  three  weeks;  and  the  patient  repeatedly  lost  blood, 
used  cathartics  with  calomel  and  senna,  and  had  frequent  antimo- 
nial  and  saline  medicines.  And  after  he  was  much  weakened 
by  evacuations,  the  peruvian  bark  and  small  doses  of  steel  re- 
moved the  fever,  but  the  tumour  remained  many  years  during  the 
remainder  of  his  life. 

In  this  case  the  tumour  of  the  spleen  was  occasioned  by  the 
torpor  of  the  absorbent  vessels;  while  the  secerning  vessels  con- 
tinued somewhat  longer  to  pour  their  fluids  into  the  cells  of  it. 
Then  the  inactivity  of  this  viscus  affected  the  whole  system  with 
torpor  by  the  deficient  excitement  of  the  sensorial  power  of 


Sup.  I.  16.  6. 


THEORY  OF  FEVER. 


503 


association,  which  contributes  along  with  the  irritation  caused  by 
their  specific  stimuli  to  actuate  the  whole  sanguiferous,  secerning, 
and  absorbent  vessels;  and  along  with  these  the  stomach,  which 
possesses  perhaps  greater  mobility,  or  promptitude  to  torpor  or 
to  orgasm,  than  any  other  part.  And  after  a time  all  these  parts 
recover  their  actions  by  the  accumulation  of  their  sensorial  power 
of  association.  But  the  spleen  not  recovering  its  action  from 
the  accumulation  of  its  power  of  irritation,  as  appeared  from  the 
continuance  of  the  tumour,  still  affects  the  stomach  by  its  defec- 
tive irritative  motions  ceasing  to  excite  the  association,  which 
ought  to  contribute  to  actuate  it. 

Hence  the  stomach  continues  torpid  in  respect  to  its  motions, 
but  accumulates  its  power  of  association;  which  is  not  excited 
into  action  by  the  defective  motions  of  the  spleen;  this  accumu- 
lation of  the  sensorial  power  of  association  now  by  its  super- 
abundance actuates  the  next  link  of  associate  motions,  which 
consists  of  the  heart  and  arteries,  into  greater  energy  of  action 
than  natural,  and  thus  causes  fever  with  strong  pulse;  which,  as 
it  was  supposed  to  be  most  frequently  excited  by  increase  of 
irritation,  is  called  irritative  fever,  or  synocha. 

Similar  to  this  in  the  small  pox,  which  is  given  by  inocula- 
tion, the  stomach  is  affected  secondarily,  when  the  fever  com- 
mences; and  hence  in  this  small-pox  the  pulsations  of  the  heart 
and  arteries  are  frequently  stronger  than  natural,  but  never 
weaker,  for  the  reasons  above  given.  Whereas  in  that  small- 
pox, which  is  caused  by  the  stomach  being  primarily  affected; 
by  the  contagious  matter  being  swallowed  with  the  saliva, 
whether  the  tonsils  are  at  the  same  time  affected  or  not,  the  pul- 
sations of  the  heart  and  arteries  become  weak,  and  the  inirri- 
tative  fever  is  produced,  as  explained  above,  along  with  the 
confluent  small-pox.  This  unfolds  the  cause  of  the  mildness  of 
the  inoculated  small-pox;  because  in  this  disease  the  stomach 
is  affected  secondarily,  whereas  in  the  natural  small-pox  it  is 
frequently  affected  primarily  by  swallowing  the  contagious  matter 
mixed  with  saliva. 

In  the  measles  I suppose  the  contagious  matter  to  be  dissolved 
in  the  air,  and  therefore  not  liable  to  be  mixed  with  the  saliva; 
whereas  the  variolous  matter  is  probably  only  diffused  in  the  air, 
and  thence  more  readily  mixed  with  the  saliva  in  the  mouth  dur- 
ing respiration.  This  difference  appears  more  probable,  as  the 
small-pox  I believe  is  always  taken  at  a less  distance  from  the 
diseased  person  than  is  necessary  to  acquire  the  measles.  The 
contagion  of  the  measles  affects  the  membranes  of  the  nostrils, 
and  the  secretion  of  tears  in  consequence,  but  never  I suspect 
the  stomach  primarily,  but  always  secondarily;  whence  the 


504 


THEORY  OF  FEVER, 


Spp.  I.  16.  r 


pulsation  of  the  heart  and  arteries  is  always  stronger  than  natural, 
so  as  to  bear  the  lancet  at  any  period  of  the  disease. 

The  great  mildness  sometimes,  and  fatality  at  other  times,  of 
the  scarlet  fever  may  depend  on  the  same  circumstance:  that  is, 
on  the  stomach  being  primarily  or  secondarily  affected  by  the 
contagious  matter,  observing  that  the  tonsils  may  be  affected  at 
the  same  time  with  the  stomach.  Should  this  prove  to  be  the 
case,  which  future  observations  must  determine,  what  certain  ad- 
vantage must  arise  from  the  inoculation  of  this  disease!  When 
it  is  received  by  the  skin  primarily  I suppose  no  sore  throat  at- 
tends it,  nor  fever  with  weak  pulse;  when  it  is  received  by  the 
stomach  primarily,  the  tonsils  are  affected  at  the  same  time,  and 
the  torpor  of  the  stomach  produces  inirritative  fever,  and  the  mor- 
tification of  the  tonsils  succeeds. 

We  may  hence  conclude,  that  when  the  torpor  of  the  stomach 
is  either  owing  to  defect  of  stimulus,  which  is  not  so  great  as  to 
impair  the  life  of  the  part,  as  in  moderate  hunger,  or  in  swallow- 
ing iced  water,  or  when  its  torpor  is  induced  by  its  catenation  or 
association  with  other  torpid  parts,  as  in  the  commencement  of 
intermittent  fevers  and  inoculated  small-pox,  that  the  subsequent 
action  of  the  heart  and  arteries  is  generally  increased,  producing 
irritative  fever.  Which  is  owing  to  the  accumulation  of  the  sen- 
sorial power  of  irritation  in  one  case,  and  of  association  in  the 
other,  contributing  to  actuate  the  next  link  of  the  catenated  or 
associated  motions.  But  when  the  torpor  of  the  stomach  is  in- 
duced by  previous  exhaustion  of  its  sensorial  powers  of  irritation 
or  of  association  by  continued  violent  action,  as  by  the  stimulus 
of  digitalis,  or  of  contagious  matter,  or  after  intoxication  from 
wine  or  opium,  a weaker  action  of  the  heart  and  arteries  suc- 
ceeds, because  there  is  no  accumulation  of  sensorial  power,  and 
a deficient  excitement  of  association.  And  finally,  as  this  weak 
action  of  the  heart  and  arteries  is  not  induced  by  exhaustion  of 
sensorial  power,  but  by  defect  of  the  excitement  of  association, 
the  accumulation  of  this  power  of  association  increases  the  ac- 
tion of  the  capillaries,  and  thus  induces  inirritative  fever. 

7.  When  any  part  of  the  system  acts  very  violently  in  fevers, 
the  sensorial  power  of  sensation  is  excited,  which  increases  the 
actions  of  the  moving  system:  whereas  the  pain,  which  arises 
from  decreased  irritative  motions,  as  in  hemicrania,  seems  to  ex- 
haust a quantity  of  sensorial  power,  without  producing  or  in- 
creasing any  fibrous  actions. 

When  the  stomach  is  primarily  affected,  as  in  inirritative  fevers 
from  contagion,  and  in  such  a manner  as  to  occasion  pain,  the 
action  of  the  capillaries  seems  to  be  increased  by  this  additional 


Set.  1. 16.  T. 


THEORY  OF  FEVER. 


505 


sensorial  power  of  sensation,  whence  extensive  inflammation  or 
mortification;  but  when  the  stomach  and  consequently  the  heart 
and  arteries  continue  their  torpidity  of  action;  as  in  confluent 
small-pox,  and  fatal  scarlatina;  this  constitutes  sensitive  inirrita- 
tive  fever,  or  typhus  gravior. 

But  when  the  stomach  is  secondarily  affected,  if  the  sensorial 
power  of  sensation  is  excited,  as  in  pleurisy  or  peripneumony, 
the  actions  of  the  heart  and  arteries  are  violently  increased,  and 
of  all  the  moving  system  along  with  them.  Thus  the  peripneu- 
mony is  generally  induced  by  the  patient  respiring  very  cold  air, 
and  this  especially  after  being  long  confined  to  warm  air,  or  after 
being  much  fatigued  and  heated  by  excessive  labour  or  exer- 
cise. For  we  can  cover  the  skin  with  ntGre  clothes,  when  we 
feel  ourselves  cold;  but  the  lungs  not  having  the  perception  of 
cold,  we  do  not  think  of  covering  them,  nor  have  the  power  to 
cover  them  if  we  desired  it;  and  the  torpor  thus  produced  is 
greater,  or  of  longer  duration,  in  proportion  to  the  previous  ex- 
penditure of  sensorial  power  by  heal  or  exertiae. 

This  torpor  of  the  lungs  affects  the  skin  with  shuddering,  and 
the  stomach  is  also  secondarily  affected;  next  follows  the  violent 
action  of  the  lungs  from  the  accumulation  of  the  power  of  irri- 
tation, and  an  inflammation  of  them  follows  this  violent  action. 
While  the  stomach  recovers  its  activity  by  the  increase  of  the 
excitement  of  the  sensorial  power  of  association,  and  along  with 
it  the  heart  and  arteries,  and  the  whole  moving  system.  Hence 
this  inflammation  occurs  during  the  hot  fit  of  fever,  and  no  cold 
fit  succeeds,  because  the  excess  of  the  sensorial  power  of  sensa- 
tion prevents  a succeeding  torpor. 

These  new  motions  of  certain  parts  of  the  system  produce  in- 
creased secretions  of  nutritious  or  organic  mucus,  which  forms 
new  vessels;  these  new  vessels  by  their  unusual  motions  produce 
new  kinds  of  fluids,  which  are  termed  contagious,  because  they 
have  the  power,  when  introduced  into  a healthy  body,  of  pro- 
ducing similar  actions  and  effects,  with  or  without  fever,  as  in 
the  small-pox  and  measles,  or  in  the  itch  and  venereal  disease. 

If  any  of  these  contagious  matters  affect  the  stomach  with  tor- 
por either  by  their  stimulus  immediately  applied,  or  by  its  sym- 
pathy with  the  parts  first  diseased,  a fever  is  produced  with  sick- 
ness and  want  of  appetite;  as  in  small-pox  and  scarlatina.  If 
the  stomach  is  not  affected  by  contagious  matter,  no  fever  suc- 
ceeds, as  an  itch,  tinea,  syphilis. 

All  these  contagious  matters  are  conceived  to  be  harmless,  till 
they  have  been  exposed  to  the  air,  either  openly  or  through  a 
moist  membrane;  from  which  they  are  believed  to  acquire  oxy- 
gene,  and  thence  to  become  some  kinds  of  animal  acids.  As 

VOL.  II.  3 T 


506 


THEORY  OF  FEVER, 


Sup.  I.  16.  S 


the  preparations  of  mercury  cure  venereal  ulcers;  as  a quarter 
of  a grain  of  sublimate  dissolved  in  wine,  and  given  thrice  a 
day;  this  effect  seems  to  be  produced  either  by  its  stimulating 
the  absorbents  in  the  ulcer  to  absorb  the  venereal  matter  before 
it  has  acquired  oxygene;  or  by  afterwards  uniting  with  it  che- 
mically, and  again  depriving  it  of  its  acquired  acidity.  On 
either  supposition  it  might  probably  be  given  with  advantage  in 
small-pox,  and  in  all  infectious  diseases,  both  previous  to  their 
commencement,  and  during  their  whole  progress. 

8.  The  cold  fits  of  intermittent  fevers  are  caused  by  the  tor- 
por of  some  part  owing  to  deficient  irritation,  and  of  the  other 
parts  of  the  system  from  deficient  association.  The  hot  fits  are 
owing  first  to  the  accumulation  of  irritation  in  the  part  primarily 
affected,  if  it  recovers  its  action,  which  does  not  always  happen; 
and  secondly  to  the  accumulation  of  association  in  the  other  parts 
of  the  system,  which  during  health  are  subject  to  perpetual  action; 
and  lastly  also  to  the  greater  excitement  of  the  power  of  associa- 
tion, when  the  pail  primarily  affected  recovers  its  irritability,  and 
acts  with  greater  energy  than  natural. 

The  deficient  secretions  in  the  cold  fit  depend  on  the  torpor  of 
the  glandular  system;  and  the  increased  secretions  in  the  hot  fit 
on  their  more  energetic  action.  The  thirst  in  the  cold  fit  isowing 
to  ihe  deficient  absorption  from  the  skin,  cellular  membrane,  and 
bladder;  the  thirst  in  the  hot  fit  is  owing  to  the  too  great  dissipation 
of  the  aqueous  part  of  the  blood.  The  urine  is  pale  and  in  small 
quantity  in  the  cold  fit  from  deficient  secretion  of  it,  and  from 
deficient  absorption  of  its  aqueous  parts;  it  is  high  coloured, 
and  sometimes  deposites  a sediment,  in  the  hot  fit,  from  the 
greater  secretion  of  it  in  the  kidneys,  and  the  greater  absorp- 
tion of  its  aqueous  and  saline  part  in  the  bladder.  The  drvness 
and  scurf  on  the  tongue  and  nostrils  are  owing  to  the  increased 
heat  of  the  air  expired  from  the  lungs,  and  consequent  greater 
evaporation  of  the  aqueous  part  of  the  mucus.  The  sweats  ap- 
pear in  consequence  of  the  declension  of  the  hot  fit,  owing  to  the 
absorbent  vessels  of  the  skin  losing  their  increased  action  sooner 
than  the  secerning  ones;  and  to  the  evaporation  lessening  as  the 
skin  becomes  colder.  The  returns  of  the  paroxysms  are  princi- 
pally owing  to  the  torpor  of  some  less  essential  part  of  the  sys- 
tem remaining  after  the  termination  of  the  last  fit;  and  are  also 
dependent  on  solar  or  lunar  diurnal  periods. 

The  torpor  of  the  part  which  induces  the  cold  paroxysm,  is 
owing  to  the  deficient  irritation  occasioned  either  by  the  subduc- 
tion  of  the  natural  stimuli  of  food,  or  water,  or  pure  air,  or  by  de- 
ficiency of  external  influences,  as  of  heat,  or  of  solar  or  lunar 
gravitation.  Or  secondly,  in  consequence  of  the  exhaustion  oi 


Sup.  I.  16.  9. 


THEORY  OF  FEVER. 


507 


sensorial  power  by  great  previous  exertions  of  some  parts  of  the 
system,  as  of  the  limbs  by  great  labour  or  exercise,  or  of  the 
stomach  by  great  stimulus,  as  by  contagious  matter  swallowed 
with  the  saliva,  or  by  much  wine  or  opium  previously  taken  into 
it.  Or  lastly,  a torpor  of  a part  may  be  occasioned  by  some  me- 
chanic injury,  as  by  a compression  of  the  nerves  of  the  part,  or 
of  their  origin  in  the  brain;  as  the  sitting  long  with  one  leg 
crossed  over  the  other  occasions  numbness,  and  as  a torpor  of  the 
stomach  with  vomiting  frequently  precedes  paralytic  strokes  of 
the  limbs. 

As  sleep  is  produced,  either  by  defect  of  stimulus,  or  by  pre- 
vious exhaustion  of  sensorial  power;  so  the  accumulation  of  the 
sensorial  power  of  volition  in  those  muscles  and  organs  of  sense, 
which  are  generally  obedient  to  it,  awakens  the  sleeping  person; 
when  it  has  increased  the  quantity  of  voluntarity  so  much  as  to 
overbalance  the  defect  of  stimulus  in  one  case,  and  the  exhaus- 
tion of  sensorial  power  in  the  other;  which  latter  requires  a 
much  longer  time  of  sleep  than  the  former.  So  the  cold  pa- 
roxysm of  fever  is  produced  either  by  defect  of  stimulus,  or  by 
previous  exhaustion  of  the  sensorial  power  of  some  part  of  the 
system;  and  the  accumulation  of  the  sensorial  power  of  irrita- 
tion in  that  part  renews  the  action  of  it,  when  it  has  increased 
its  irritability  so  much  as  to  overbalance  the  defect  of  stimulus 
in  one  case,  and  the  exhaustion  of  sensorial  power  in  the  other; 
which  latter  requires  a much  longer  torpor  or  cold  fit  than  the 
former. 

But  in  the  cold  paroxysm  of  fever,  besides  the  torpor  of  one 
part  of  the  system  from  defect  of  irritation,  the  remainder  of  it 
becomes  torpid  owing  to  defect  of  excitement  of  the  sensorial 
power  of  association  by  the  lessened  action  of  the  part  first  af- 
fected. This  torpor  of  the  general  system  remains,  till  the  ac- 
cumulation of  the  sensorial  power  of  association  has  increased 
the  associability  so  much  as  to  overbalance  the  defect  of  the  ex- 
citement of  association;  then  the  torpor  ceases,  and  if  the  first 
affected  part  has  recovered  its  activity,  the  other  parts  are  all 
thrown  into  excess  of  action  by  their  increased  associability,  and 
the  hot  fit  of  fever  is  produced. 

9.  In  the  continued  fevers  with  strong  pulse  the  stomach  is 
affected  secondarily,  and  thus  acts  feebly  from  deficient  excite- 
ment of  the  power  of  association;  but  the  accumulation  of  the 
power  of  association  thus  produced  in  an  organ  subject  to  perpe- 
tual and  energetic  action,  is  so  great  as  to  affect  the  next  link  of 
the  associate  train,  which  consists  of  the  heart  and  arteries;  these 
therefore  are  exerted  perpetually  with  increase  of  action. 

In  continued  fevers  with  weak  pulse  the  torpid  stomach  is 


50S 


THEORY  OF  FEVE& 


Sup.  I.  16.  9. 


affected  primarily  by  previous  exhaustion  of  its  irritability  by  sti- 
mulus, as  of  contagious  matter  swallowed  into  it.  The  heart  and 
arteries  act  feebly  from  deficient  excitement  of  the  power  of  as- 
sociation, owing  to  the  torpor  of  the  stomach,  with  which  they 
are  catenated;  but  the  accumulation  of  the  power  of  association, 
thus  produced  in  organs  subject  to  perpetual  and  energetic  mo- 
tion, is  so  great,  as  to  affect  the  next  link  of  the  associate  train; 
which  consists  of  the  capillaries  of  the  skin  or  other  glands;  these 
therefore  are  exerted  perpetually  with  great  increase  of  action. 

The  continued  fevers  with  strong  pulse  terminate  by  the  re- 
duction or  exhaustion  of  the  sensorial  power  by  violent  action  of 
the  whole  system;  which  is  followed  either  by  return  of  health 
with  the  natural  quantity  of  irritability,  and  of  associabi- 
lity,  or  by  a total  destruction  of  them  both,  and  consequent 
death. 

In  continued  fevers  with  weak  pulse  the  stomach  remains 
torpid  during  the  whole  course  of  the  fever;  and  at  length  by 
the  recovery  of  its  irritability  and  sensibility  effects  the  cure  of 
it.  Which  generally  happens  about  the  first,  second,  or  third 
quarter  of  the  lunar  period,  counted  from  the  commencement 
of  the  disease,  or  continues  a whole  lunation,  and  sometimes 
more;  which  gave  rise  to  what  are  termed  critical  days.  See 
Sect.  XXXVI.  4.  on  this  subject.  If  the  stomach  does  not  re- 
cover from  its  torpor,  the  patient  becomes  emaciated,  and  dies 
exhausted  by  the  continuance  of  the  increased  action  of  the  ca- 
pillaries and  absorbents,  and  the  want  of  nourishment. 

The  cure  of  continued  fever  with  weak  pulse  consists  first  in 
weakening  the  undue  action  of  the  capillaries  of  the  skin  by  ab- 
lution with  cold  water  from  32  to  80  degrees  of  heat;  or  by  ex- 
posing them  to  cool  air.  Secondly,  by  invigorating  the  actions 
of  the  stomach,  by  decreasing  them  for  a time,  and  thence  ac- 
cumulating the  power  of  irritation,  as  by  an  emetic,  or  by  iced 
water,  or  iced  wine.  Or  by  increase  of  stimulus,  as  by  bark, 
wine,  opium,  and  food,  in  small  quantities  frequently  repeated. 
Or  by  renewing  the  action  of  the  stomach  by  slight  electric 
shocks.  Or  by  fomenting  it  frequently  with  water  heated  to  96 
or  100  degrees.  Or  lastly,  by  exciting  its  power  of  association 
with  other  parts  of  the  system,  as  by  a blister;  which  succeeds 
best  when  the  extremities  are  cool;  or  by  swinging,  as  in  vertigo 
rotatoria. 

If  by  the  stimulus  of  the  Peruvian  bark  on  the  fibres  of  the 
stomach,  they  regain  their  due  action,  the  heart  and  arteries  also 
regain  their  due  action;  as  their  sensorial  power  of  association 
is  now  excited,  and  expended  as  usual.  And  as  there  is  then 
no  accumulation  of  sensorial  power  in  the  heart  and  arteries,  the 


Sop  I.  16. 10. 


THEORY  OF  FEVER. 


509 


capillaries  cease  to  act  with  too  great  energy,  and  the  fever  is 
cured. 

Thirdly.  If  the  heart  and  arteries  could  be  themselves  stimu- 
lated into  greater  action,  although  the  stomach  remained  tor- 
pid, they  might  probably,  by  expending  a greater  quantity  of  the 
sensorial  power  of  irritation,  prevent  an  accumulation  of  the 
sensorial  power  of  association,  (for  these  may  possibly  be  only 
different  modes  of  action  of  the  spirit  of  animation,)  and  thus 
the  too  great  action  of  the  capillaries  might  be  prevented  and 
the  fever  cease.  This  new  mode  of  cure  might  possibly  be  ac- 
complished, if  the  patient  was  to  breathe  a gallon  or  two  of  pure 
or  diluted  oxygene  gas  frequently  in  a day;  which  by  passing 
through  the  moist  membranes  of  the  lungs  and  uniting  with  the 
blood  might  render  it  more  stimulant,  and  thus  excite  the  heart 
and  arteries  into  greater  action. 

Fourthly.  Greater  energy  might  probably  be  given  to  the 
whole  system,  and  particularly  to  those  parts  which  act  too  feebly 
in  fevers,  as  the  stomach  and  the  heart  and  arteries,  if  the 
action  of  the  secerning  vessels  of  the  brain  could  be  increased  in 
energy;  this  is  probably  one  effect  of  all  those  drugs,  which 
when  given  in  large  quantity  induce  intoxication,  as  wine  and 
opium.  And  when  given  with  great  caution  in  small  quanti- 
ties uniformly  repeated,  as  from  three  drops  to  five  of  the  tinc- 
ture of  opium,  but  not  more,  every  six  hours,  I believe  they  sup- 
ply an  efficacious  medicine  in  fevers  with  great  arterial, debility; 
and  the  more  so,  if  the  Peruvian  bark  be  exhibited  alternately 
every  six  hours  along  with  them.  There  are  other  means  of  ex- 
citing the  vessels  of  the  brain  into  action;  as  first  by  decreasing 
the  stimulus  of  heat  by  temporary  cold  fomentation;  secondly, 
increasing  the  stimulus  of  heat  by  long  continued  warm  fomen- 
tation; thirdly,  by  electricity,  as  very  small  shocks  passed  through 
it  in  all  directions;  and  lastly,  by  blisters  on  the  bead.  Ail  those 
require  to  be  used  with  great  caution,  and  especially  where  there 
exists  an  evident  stupor,  as  the  removing  of  that  is,  I believe, 
frequently  injurious.  See  Stupor,  Class  I.  2.  5.  10. 

The  cure  of  fever  with  strong  pulse  consists  in  the  repeated 
use  of  venesection,  gentle  cathartics,  diluents;  medicines  pro- 
ducing sickness,  as  antimonials,  digitalis;  or  the  respiration  of 
carbonated  hydrogen;  or  by  respiration  of  atmospheric  air  low- 
ered by  a mixture  of  hydrogen,  azote,  or  carbonic  acid  gas,  or 
by  compressing  the  brain  by  whirling  in  a decumbent  posture,- as 
if  lying  across  a horizontal  mill-stone.  See  the  former  parts  of 
this  supplement  for  the  methods  of  cure  both  of  fevers  with 
strong  and  weak  pulse. 

10.  When  any  difficulty  occurs  in  determining  the  weak 


510 


THEORY  OF  FEVER. 


Sup.  I.  16. 10. 


pulse  from  the  strong  one,  it  may  generally  be  assisted  by  count- 
ing its  frequency.  For  when  an  adult  patient  lies  horizontally 
in  a cool  room,  and  is  not  hurried  or  alarmed  by  the  approach  of 
his  physician,  nor  stimulated  by  wine  or  opium,  the  strong  pulse 
seldom  exceeds  118  or  120  in  a minute;  and  the  weak  pulse 
is  generally  not  much  below  130,  and  often  much  above  that 
number;  except  where  a patient  has  naturally  a pulse  slower 
than  usual  in  his  healthy  state.  Secondly,  in  sitting  up  in  bed, 
or  changing  the  horizontal  to  a perpendicular  posture,  the  quick- 
ness of  the  weak  pulse  is  liable  immediately  to  increase  10  or 
20  pulsations  in  a minute,  which  does  not,  I believe,  occur  in  the 
strong  pulse,  when  the  patient  has  rested  himself  after  the  exer- 
tion of  rising. 

I shall  here  insert  a remark  on  the  general  use  of  stimulating 
materials,  whether  medicinal  or  culinary,  to  counteract  or  pre- 
vent debility.  When  a stimulating  material  is  exhibited,  as  the 
Peruvian  bark,  or  opium,  or  wine;  it  should  be  continued  but 
a certain  time,  as  half  a lunation,  or  a whole  lunation.  If  the 
whole  system  be  stimulated  into  increased  exertion,  as  by  wine 
or  opium,  there  appears  to  be  a temporary  increased  secretion  of 
sensorial  power  in  the  brain,  so  long  as  this  stimulus  affects  the 
system.  If  a part  only  of  the  system  be  stimulated,  as  by  the 
exhibition  of  spices,  essential  oils,  or  bitter  medicines,  or  metal- 
lic ones,  then  the  stimulated  organ  has  derived  to  it  a greater 
quantity  of  sensorial  power,  or  a greater  secretion  of  it  is  pro- 
duced in  that  part  of  the  brain,  where  the  stimulated  nerves 
arise.  Which  is  probably  owing  to  the  sympathy  of  the  stimu- 
lated extremity  of  every  nerve,  or  its  organ  of  sense,  with  the 
other  extremity  of  it  in  the  brain,  in  the  same  manner  as  when 
the  excretory  duct  of  a gland  is  stimulated,  a greater  secretion 
is  produced  in  the  body  of  it,  as  when  the  ducts  of  the  lachrv mal 
glands  in  the  eyes,  or  of  the  salivary  glands  in  the  mouth,  are 
stimulated  by  dust  or  acrid  materials. 

Now  if  a stimulating  medicine  be  given  at  certain  intervals  of 
time,  as  the  Peruvian  bark  or  wine  in  fevers,  the  increased  ac- 
tion of  a part  or  of  the  whole  system  soon  becomes  a link  of 
the  associated  circle  of  diurnal  actions,  and  may  be  said  to  be- 
come habitual. 

The  quantity  of  the  stimulating  medicine  may  then  be  dimi- 
nished, and  yet  the  increased  activity  of  the  system  will  continue; 
because  the  increased  exertions  are  now  produced  partly  by  the 
sensorial  power  of  association,  as  they  are  become  a part  of  the 
diurnal  circle  of  actions.  And  finally  the  stimulating  medicine 
may  be  totally  omitted,  and  yet  the  increased  activity  of  the  sys- 
tem continue  for  the  same  reason. 


fccp.I.  17. 


TBEORY  OF  FEVER. 


511 


On  this  circumstance  depends  the  power  of  the  bitter  medi- 
cines, as  the  bark,  and  other  stimulating  materials,  as  beer  and 
wine,  in  preventing  the  returns  of  the  cold  paroxysms  of  fevers, 
and  in  strengthening  the  system,  which  increase  of  irritability, 
that  is,  of  strength,  continues  after  the  use  of  the  medicine  is  with- 
drawn. 

But,  on  the  contrary,  if  the  stimulating  material  be  continued 
much  longer  than  one  lunation,  the  whole  system,  or  the  stimulated 
organ  alone,  is  excited  into  too  forcible  action  by  the  two  senso- 
rial powers  of  irritation,  and  of  association;  and,  consequently,  in 
proeess  of  time,  loses,  in  some  degree,  both  its  irritability  and  its 
associability;  and  inactivity  or  torpor  succeeds;  which  constitutes 
weakness,  as  is  seen  in  all  those  who  accustom  themselves  to 
dram-drinking. 

Hence  wine  or  opium,  or  Peruvian  bark,  may  be  continued 
twice  or  four  times  a day  for  half  a lunation,  or  for  a whole  one 
with  advantage,  in  diseases  of  debility,  for  the  purpose  of  gaining 
both  diurnal  and  monthly  associations  of  activity.  But  should 
not  be  much  longer  continued;  as  a consequent  debility  will  then 
be  liable  to  succeed. 


XVII.  Conclusion. 

Thus  have  I given  an  outline  of  what  may  be  termed  the  sym- 
pathetic theory  of  fevers,  to  distinguish  it  from  the  mechanic 
theory  of  Boerhaave,  the  spasmodic  theory  of  Hoffman  and  of 
Cullen,  and  the  putrid  theory  of  Pringle.  What  I have  thus  de- 
livered, I beg  to  be  considered  rather  as  observations  and  conjec- 
tures, than  as  things  explained  and  demonstrated;  to  be  considered 
as  a foundation  and  a scaffolding,  which  may  enable  future  indus- 
try to  erect  a solid  and  a beautiful  edifice,  eminent  both  for  its 
simplicity  and  utility,  as  well  as  for  the  permanency  of  its  mate- 
rials,— which  may  not  moulder,  like  the  structures  already  erect- 
ed, into  the  sand  of  which  they  were  composed;  but  which  may 
stand  unimpaired,  like  the  Newtonian  philosophy,  a rock  amid 
the  waste  of  ages ! 


END  OF  THE  SECOND  PART. 


LINES, 


TO  BE  PLACED  AT  THE  END  OF 

ZOONGM1A. 

BY  A FRIEND. 


JAMQ.tTE  OPUS  EXEGI, 


The  work  is  done  ! — nor  Folly’s  active  rage, 
Nor  Envy’s  self,  shall  blot  the  golden  page  ; 
Time  shall  admire,  his  mellowing  touch  employ, 
And  mend  the  immortal  tablet,  not  destroy. 


ZOONOMLE  AUCTORI 

S.  P.  D. 

AMICUS. 


CE'RRUS  TRIUMPHALIS  MEDICItfJE. 


Currus  it  Ilygeix,  Medicos  movet  arma  triumphans, 
Undique  victa  fugit  lurida  turmamali. — 

Laurea  dum  Phcebi  viridis  tua  tempora  cingit, 

Nec  mortale  sonans  Fama  coronat  opus; 

Post  equitat  trepidans,  repetitque  Senectus  in  aurem, 
Yoce  canens  stridula,  “ sis  mentor  ipse  mori !” 


INDEX 


TO  THE 

CLASSES  OF  PART  SECOND. 


A 

ABORTION,  i.  2,  1,14. 

from  fear,  iv.  3,  1,  7. 
not  from  epilepsy,  iii. 
1,  1,  7. 

not  from  hepatitis,  ii. 

1,2,12. 

Absorption  of  solids,  i.  2,  2,  14. 

of  matter,  ii.  1,  6,  2,  and 

6. 

cellular,  iv.  1,  1,  6. 
from  the  lungs,  iv.  3,  1. 
5.  Suppl.  i.  8,  6. 

Abstinence  of  young  ladies,  ii.  2, 

2,  1. 

Accumulation  of  feces,  ii.  2,  2,  7. 
Acupuncture,  iii.  1,  1,  8. 

Adipsia,  ii.  2,  2,  2- 
jEgritudo  ventriculi,  i-  2,  4,  4. 

See  Sickness. 

Agripnia.  See  Yigilia. 

Ague  cakes,  Suppl.  i-  2,  3. 

Alum  in  ulcers  of  the  mouth,  ii.  1, 
3,  1.  ii.  1,  6, 16. 

Ambition,  iii.  1,  2,  9. 

Amaurosis,  i.  2,  5,  5. 

Anasarca  of  the  lungs,  i.  2,  3, 16. 
Aneurisma,  i.  2,  1,  18. 

Anger,  iii.  1,  2, 17. 

tremor  of,  iv  2,  3,  4. 
blush  of,  iv.  2,  3,  5. 

Angina.  See  Tonsillitis. 

pectoris.  See  Asthma 
painful. 

Anhelitus,  ii.  1,  1,  4. 

Anhelatio  spasmodica,  i.  3,  3,  3. 
Annulus  repens,  ii.  1,  5, 10. 
Anorexia,  ii.  2,  2,  1. 

maniacalis,  Suppl.  i.  14, 3. 
epileptics,  ii.  2,  2,  l.  iii. 

1,  1,  7- 


Apepsia,  i.  3,  1,  3.  Suppl.  i.  8,  11. 
Aphtha,  ii.  1,  3,  17. 

Apoplexy,  iii.  2,  1,  16. 

Appetite  defective,  ii.  2,  2,  1. 

depraved,  iii.  1,  2,  19. 
from  abstinence,  ii.  2,  2,  1 
destroyed,  iii.  1,  2,  20. 
from  epilepsy,  ii.  2,  2,  1. 
Arm,  pain  of,  iv.  2,  2, 13. 

palsy  of,  iii.  2,  1,  4. 

Arsenic  in  tooth-ach,  i.  2,  4,  12. 

in  head-ach,  i.  2,  4,  11. 
Arthrocele,  ii.  1,  4,  17. 
Arthropuosis,  ii.  1,  4,  18. 

Arthritis.  See  Gout. 

Ascarides,  i.  1,  4,  12,  iv.  1,  2,  9,  iv. 

2,  2,  6. 

Ascites,  i.  2,  3,  13. 

Associations  affected  four  ways,  iv. 

1,  1.  G. 

how  produced,  iv.  1,  1. 
H. 

distinct  from  catena- 
tions, iv.  1,  1.  A. 
three  kinds  of,  iv.  1,  1. 
B. 

tertian,  iv.  1,  1.  K. 
of  the  fauces  and  pu- 
bis, iv.  1,  2,  7. 
sensitive,  a law  of,  iv.  2, 

2,  2. 

sensitive,  iv.  2,  1. 
accumulates,  Suppl.  i. 
8,3,  i.  11,  4. 

Asthma  humoral,  ii.  1,  1,  8,  i.  3,  2,  8. 
of  infants,  i.  1,  3,  4. 
convulsive,  iii.  1,  1, 10. 
painful,  iii.  1,  1,  11. 

Auditus  acrior,  i.  1,  5,  2. 

imminutus,  i.  2,  5,  6. 

Azote,  Suppl.  i.  9,  3,  ii.  11,  4. 
sceptic,  ii.  1,  6,  6. 

3 U 


VOL.  II. 


514 


INDEX  TO  THE  CLASSES.— Paht  II. 


B 

Bandages,  ill  effects  of,  ii.  1,  1,  12. 

promote  absorption,  i.  1, 
3,  13 

in  gout,  iv.  1,  2,  15. 
in  rheumatism,  iv.  1,  2, 
16. 

in  hemicrania,  iv.  2,  2,  8. 
in  epilepsia,  iii.  1,  1,  7. 
Bath,  cold,  i.  2,  2,  1.  Suppl.  1, 14,  3. 

warm,  i.  1,  2,  3. 

Beauty,  iii.  1,  2,  4 

loss  of,  iii.  1,  2,  12. 
Bile-duct,  pain  of,  iv.  2,  2,  4. 

Bile  crystallized,  i.  1,  3,  8. 

Bitter  taste,  i.  1,  3,  1. 

not  from  bile,  i.  1,  3,  1. 
Bleeding.  See  Hemorrhage. 
Bladder,  distention  of,  ii.  2,  2,  6. 
stone  of,  i.  1,  3,  10. 
catarrh  of,  ii.  1,  4,  11. 
Blindness,  i 2,  5,  5. 

Blush  of  anger,  iv.  2,  3,  5.  Suppl.  i. 
12  7. 

of  guilt,  iv.  2,  3,  6.  Suppl.  i. 
12,  7. 

Bones,  innutrition  of,  i.  2,  2,  14. 

caries  of,  ii.  1,  4,  19. 
Borborigmus,  i.  3,  1,  9. 

Bougies,  ii.  1,  4,  11 
Bowels,  gurgling  of,  i.  3,  1,  9. 
Brachiorum  paralysis,  iii.  2,  1,  4. 
Brain  stimulated,  Suppl.  i.  16,  9. 
Bronchocele,  i.  2,  3,  20. 

Broth,  i.  2,  4,  8. 

Burns,  i.  1,  3,  13. 

Butterflies,  experiment  on,  i.  1,  2, 3. 
Buxton  bath  feels  warm,  Suppl.  i.  16. 

C 

Cacositia,  iii.  1,  2,  20. 

Calculi  productio,  i.  1,  3,  9,  ii.  1,  2, 
14. 

renis,  i.  1,  3,  9,  iv.  2,  3.  3. 
vesicae,  i 1,  3, 10,  iv.  2,  2,  2. 
Callico  shirts,  i.  1,  2,  3. 

Callus,  i.  2,  2,  12. 

Canities.  See  Hair,  grey. 

Calor  febrilis,  i.  1,  2,  1. 

Calves  fed  on  gruel,  i.  1,  2,  5. 

hydatides  of,  i.  2,  5,  4. 
Cancer,  ii.  1,  4,  16,  ii.  1,  6,  13. 
Cantharides,  large  dose  of,  iv.  2, 2, 2. 
Carbonic  acid  gas,  Suppl.  i.  9,  3. 
Cardialgia,  i.  2,  4,  5. 

Carcinoma,  ii.  1,  4,  16,  ii.  1,  6,  13. 
Caries  ossium,  ii.  1,  4,  19. 


Cataract,  i.  2,  2, 13. 

Catarrh,  warm,  i.  1,  2,  7. 
cold,  i.  2,  3,  3. 
lymphatic,  i.  3,  2,  1 . 
sensitive,  ii.  1,  3,  5. 
epidemic,  ii.  1, 3,  6. 
of  dogsand  horses,  ii.  1,3,6. 
from  cold  skin,  iv.  1,  1,  5. 
periodic,  iv.  3,  4,  1. 
Catamenia,  i.  2,  1,  10,  iv.  2,  4,  7. 
Catalepsis,  iii.  2,  1,  9. 

Cats,  mumps  of,  ii.  1,  3,  4- 
Cephalzea,  sympathetica,  iv.  2,  2,  7. 

idiopathica,  i 2,  4,  11. 
somniosa,  i.  2,  4,  11. 
Cesarian  operation,  i.  2,  2,  14. 
Charcoal  tooth-powder,  i.  2,  4, 12. 
Cheek,  torpor  of,  iv.  2,  2, 1. 

Chicken  pox,ii.  1,3,  15. 
Chin-cough,  ii.  1,  3,  8. 

Child-bed  fever,  ii.  1.  6,  16. 
Children,  new%born,  ii.  1,  1,  12. 

gripes  and  purging  of,  i 
1,  2,  5. 

Chlorosis,  i.  2,  3, 10.  Suppl.  i.  8,  11 
Chorea  St.  Viti,  iv.  2,  3,  2. 

Citta,  iii.  1,  2,  19. 

Clamor,  iii.  1,  1,  3. 

Clavicular  animals,  ii.  1,  2,  6. 

Clavus  hystericus,  iv.  2,  2,  8. 
Claudicatio  coxaria,  i.  2,  2,  17. 

Cold  in  the  head.  See  Catarrh. 
Cold  air  in  fevers,  iii.  2, 1,  12,  iv.  2, 
4, 11. 

effects  of,  iii  2,  1,  17. 
howto  be  used,  iv.  1,  1,  4. 
death  from,  iii.  2,  1,  17. 

Colic,  flatulent,  i.  2,  4,  7. 
from  lead,  i.  2,  4,  8. 
hysteric,  i.  2,  4,  7,  iii.  1,  1, 8 
Compassion,  iii.  1,  2,  24. 
Consumption,  ii.  1,  6,  7. 

Convulsion,  iii.  1,  1,  5. 

weak,  iii.  1,  1,  5. 
from  bad  air,  iii.  1,  1, 
painful,  iii.  1,  1,  6,  iv. 
4,5. 

Consternation,  i.  1,  5,  12. 
Constipation,  i.  1,  3,  5,  ii.  2,  1,  7. 
Contagious  matter  of  two  kinds,  ii. 

1,  3. 

is  oxygenated,  ii. 
1,5. 

produces  fever, 
how,  Suppl.  i. 
16,  7. 

destroyed  by  ni- 
trous vapour, 
ii.  1,  3. 


*0  ci 


INDEX  TO  THE  CLASSES.— Part  II. 


515 


Contagious  matter  destroyed  by  sul- 
phurous vapour,  ii.  1,  3. 

Cornea,  to  perforate,  i.  1,  3 14. 

scars  of,  seen  on  milk,  i.  1, 
3,  14. 

Corpulency,  i.  2,  3,  17. 

Coryza.  See  Catarrh. 

Costiveness,  i.  1,  3,  5,  ii.  2,  1,  7. 
Cough  of  drunkards,  ii  1,  1,  5. 
hooping,  ii.  1,  3,  8. 
hepatic,  iv.  2,  1,  8. 
gouty,  iv.  2,  1,  9. 
periodic,  iv.  2, 4,  6,  iv.  3, 4,  2. 
from  cold  feet,  iv.  2,  1,7. 
Cows,  pestilence  of,  ii.  1,  3,  13. 
bloody  urine  of,  ii.  1,  3,  13. 
swelled  by  clover,  ii.  1,  7. 
Cow-pox,  ii.  1,  3,  9. 

Crab-lice,  i.  1,  4,  14. 

Cramp,  iii.  1,  1,  13. 

painful,  iii.  1,  1,  14. 
in  diarrhoea,  iv.  1,  2,  10. 
Crapula  ventriculi,  ii.  1,  1,  7. 
Credulity,  iii.  2,  2,  4. 

Crines  novi,  i.  1,  2,  15. 

Croup,  i.  1,  3,  4,  ii.  1,  2,  4,  ii.  1,  3,  3. 
Crusta  lactea,  ii.  1,  5, 12. 

Cutis  arida,  i.  1,  3, 6 
Cynanche.  See  Tonsillitis. 

parotidxa.  See  Paro- 
titis. 

D 

Darkness  in  fevers,  i.  2,  5,  3. 
Deafness,  two  kinds  of,  i.  2,  5,  6. 
Debility,  three  kinds  of,  i.  2,  1. 
Debility  and  strength  metaphors,  i, 
2,  1 . 

Decussation  of  nerves,  iii.  2, 1, 10. 
Deglutition,  ii.  1,  1,  1, 

involuntary,  iv.  1,  3,  1. 
Delirium,  febrile,  ii.  1,  7,  1. 

of  drunkenness,  ii.  1, 7,  3. 
maniacal,  ii  1,7,  2. 
in  parotitis,  iv.  2,  1,  19. 
Dentition,  i.  1,  4,  5, 

Dentium  dolor  a stridore,  iv.  1,  2, 3, 
Descent  of  the  uterus,  i.  1,  4,  8. 
Diabetes,  i.  3,  2,  6. 

foul  tongue  in,  i.  1,  3, 1. 
irritative,  iv.  3,  1,  1. 

' from  fear,  iv.  3,  1,  3. 
Diarrhoea  warm,  i.  1,  2,  5. 

of  infants,  i.  1,  2,  5. 
lymphatic,  i.  3,  2,  4. 
chyliferous,  i.  3,  2,  5. 
cold,  i.  2,  3,  6. 
rheumatic,  iv.  2, 1, 16. 


Diarrhoea  from  fear,  iv.  3,  1,  4. 

from  toothing,  iv  2,  2,  14, 
in  fevers,  Suppl.  i.  2,  4. 
cure  of,  iv.  i.  1.  F. 

Digestion  increased  by  cold,  iv.  1, 

1.4. 

decreased  by  cold,  iv.  1, 

2.5. 

Digitalis  in  rheumatism,  iv.  1,  2,  16. 
Diluents,  use  of,  ii.  1,  2,  1. 
Distention  of  the  nipples,  ii.  1,  7, 10, 
iv.  1,  2,  7. 

Diuretics  useless  in  dropsy,  i.  1,  3, 7. 
Dizziness.  See  Vertigo. 

Dogs,  catarrh  of,  ii.  1,  3,  6. 

Dolor  digiti  sympathet.  iv.  2,  2,  12. 
ductus  choledochi,  iv.  2,  2,  4. 
humeri  in  hepatidite,  iv.  2,  2, 
9. 

pharyngis  ab  acido,  iv.  2,  2,  5, 
testium  nephriticus,  iv.  2,  2, 

11. 

urens,  i.  1,  5,  10. 

Dracunculus,  i.  1,  4,  13. 

Dreams,  ii.  1,  7,  4. 

Dropsy  of  the  brain,  i.  2,  3,  12. 
of  the  belly,  i.  2,  3|  13. 
of  the  chest,  i 2,  3, 14. 
of  the  ovary,  i.  2,  3, 15. 
of  the  lungs,  i.  2,  3,  16. 
of  the  scrotum,  i 2,  3,  11. 
Dysentery,  ii.  1,  3,  18. 
Dysmenorrhagia,  i.  2,  1,  12. 
Dyspepsia,  i,  3, 1,  3. 

a frig'ore,  iv.  2.  1,  6. 
Dyspnoea  from  cold  bath,  iv.  2,  1,  5. 

rheumatica,  iv.  2,  1,  16. 
Dysuria  insensitiva,  ii.  2,  2,  6. 
paralytica,  iii.  2, 1,  6. 

E 

Ears,  discharge  behind,  i.  1,  2,  9. 

noise  in  them,  iv.  2,  1, 15. 
Ear-ach,  iv.  2,  2,  8. 

Ebrietas,  i.  1, 1,  2. 

Education,  iii.  2, 1,  8,  iii.  1,  2,  24,  iii, 

1,  2,11. 

heroic,  iii.  1,  2,  25. 

Egg  boiled  for  inflamed  eyes,  ii.  1, 
4,1. 

boiled  soonest,  Suppl.  i.  7. 
life  of,  iv.  1,  4,  1. 

Electric  shocks,  iv.  1,  4,  5. 

in  paralysis,  iii.  2, 
1,  10. 

in  scrofula,  i.  2,  3, 

21. 


516 


INDEX  TO  THE  CLASSES.— Part  II. 


Electric  shocks  in  hoarseness,  iii.  2, 
1,5. 

Electrized  zinc  and  silver,  i.  2,  5,  5, 
iv.  2,  1,  11. 

Empyema,  ii.  1, 6,  4. 

Ennui,  iii.  1,  2, 11,  iii  2,  1,8. 
Enteralgia,  rheumatica,  iv.  1,  2,  16. 
Enteritis,  ii.  1,  2,  11. 

superficialis,  ii.  1,  3,  10. 
Epilepsy,  iii  1,  1,  7,  iv.  3,  1,  6. 

painful,  iii.  1, 1,  8,  iv.  2,  4, 
4. 

terminates  with  sleep,  iii. 

1,  1 

in  parturition,  iii  1,  1,  7. 
with  digestion,  ii.  2,  2,  1. 
Epistaxis.  See  Hsemorrhagia. 
Epoulosis.  See  Cicatrix. 
Erotomania,  iii.  1,  2,  4. 

Eructation,  voluntary,  iv.  3,  3,  3. 
Eruption  of  small-pox,  iv.  2,  1,  12, 
iv.  2,  2,  10. 

Erysipelas,  iv.  1,  2, 17,  ii.  1,  3,  2,  iv. 
2,  4, 10. 

seldom  suppurates,  why, 
n.  1,  o,  2. 

F.suries,  i.  2,  4,  2- 
Ether,  to  purify,  i.  2,  5,  6. 

Evil,  i.  2,  3,  21. 

Expectoration,  warm,  i.  1,  2,  8. 

solid,  i.  1,  3, 4. 
cold,  i.  2,  3,  4. 

Exsudation  behind  the  ears,  i.  1,  2, 
9. 

Eyes,  blue  under  the,  i.  2,  2,  2,  ii.  1, 
4,4. 

Eye-wing,  ii.  1,  4,  2. 

Eye-lids,  red,  ii.  1,  4,  3. 

Eye-lid,  inverted,  cure  of,  ii.  1,  1,  8. 
coloured  with  antimony,  ii. 
1,  4,  3. 

Excoriations,  iii.  2,  1,  10. 

F 

Face,  pimpled,  ii.  1,  4,  6. 

red  after  meals,  Suppl.  i.  12, 
7. 

flushed  after  dinner,  iv.  1,1,1. 
Fat  people,  why  short  breathed,  ii. 
1,1,  4 

how  to  reduce,  i.  2,  3, 
17. 

Fear,  syncope  from,  i.  2,  1,  4. 
abortion  from,  iv.  1,  3,  7. 
produces  absorption,  ii.  1, 6,  4. 
paleness  in,  iv.  1,  3,  5. 
of  death,  iii.  1,  2,  14. 
of  hell,  iii.  1)  2,  15, 


Fear  of  poverty,  iii.  1,  2,  13. 

Feet,  cold,  produces  heartburn, 
Suppl.  i.  8,  5. 
fetid,  i.  1.  2,  14. 
cold  in  small-pox,  iv.  2,  2, 
i0. 

Fevers,  five  kinds,  ii.  1,  2.  Suppl.  i 

1,2. 

irritative,  i.  1,  1,  1,  iv.  1,  1, 
8 

inirritative,  i.  2, 1, 1,  iv.  2, 1, 
19.  Suppl.  i.  1,  2. 
sensitive,  ii.  1,  5,  1. 
sensitive  irritated,  ii.  1,  2,  1. 
sensitive  inirritated,  ii.  1,  3, 
1. 

intermit,  why,  Suppl.  i. 
continue,  why,  Suppl.  i. 
periods  of,  iv,2,  4, 11. 
simple,  Suppl. i.  1. 
compound,  Suppl.  i.  2. 
termination  of  cold  fit, 
Suppl.  i 3. 

return  of  cold  fit,  Suppl.  i.  5. 
sensation  in,  Suppl.  i.  5. 
circles  of  motions  in,  Suppl. 
i.  6. 

cold  and  hot  fits  Suppl.  i.7. 
continued,  Suppl.  i.  8. 
torpor  of  lungs  in,  Suppl.  i. 
9,  1. 

not  determinable  in  cold  fit, 

1.  1,  1,  1. 

frequency  of  pulse  in,  i.  1, 

1.  1. 

not  an  effort  to  cure,  i.  1, 

2,  3. 

from  enclosed  matter,  ii.  1, 

6,  2. 

from  aerated  matter,  ii.  1,  6, 

6. 

from  contagious  matter,  ii.  1, 
6 11. 

from  contagious  sanies,  ii.  1, 
6.  15. 

puerperal,  ii  1,  6,  16. 
torpor  of  the  stomach  in, 
Suppl.  i.  12. 
case  of,  Suppl.  i.  13. 
termination  of.  Suppl  i.  14. 
inflammation  excited  in, 
Suppl  i.  15. 
returns  of,  Suppl.  i.  4. 
when  cold  air  in,  Suppl.  i. 
2,  2. 

sympathetic,  theory  of, 
Suppl.  i. 

duration  of,  explained.. 
Suppl.  i.  2,  5. 


INDEX  TO  THE  CLASSES.— Pabt  II. 


517 


Finders,  playiner  with,  iv.  1,  3,  4. 

pain  of,  iv.  2,  2,  12. 

Fire,  animal,  iv.  1,  4,  5. 

Fish,  live  long'd1  with  injured  brain, 
i.  2,  5,  10. 

Fistula  in  ano,  ii.  1,  4,  10. 

lacrymalis,  ii.  1,  4,  9. 
in  urethra,  ii.  1,  4,  11. 
Flannel  shirt  in  diarrhcra,  iv.  1,  1,  3. 

injurious  in  summer,  i. 
1,  2,  3. 

Fluor  albus  warm,  i.  1.  2,  11. 

cold,  i.  2,  3,  7. 

Frigus  febrile,  i.  2,  2,  1. 

chronicum,  i.  2,  2,  2. 
lethale,  iii.  2,  1,  17. 

G 

Galvanism,  i.  2,  5,  5,  iv.  2,  1,  11. 
Gall-stone,  i.  1,  3,  8. 

Gangrene,  ii.  1,  6,  17. 

Gargles,  ii.  1 , 3,  3. 

Gastritis,  ii.  1,  2,  10. 

Gastritis  superficialis,  ii.  1,  3,  19. 
Genu  tumor  albus,  i 2,  3,  19. 

Gleet.  See  Gonorrhoea. 

Globus  hystericus,  i.  3,  1,  7. 
Gonorrhoea  warm,  i.  1.  2,  10. 
cold,  i.  2,  3,  8. 
venereal,  ii.  1,  5,  1. 

Gout,  iv.  1,  2, 15,  iv.  2,  4,  9. 
of  the  liver,  ii.  1,  1,  7. 
cases  of,  iv.  1,  2,  15. 
cough,  iv.  2,  1,  9. 
of  the  stomach,  i.  2,  4,  6. 
hemorrhage  in,  i.  1,  1,  4. 
Grace  defined,  iii.  1,  2.  4. 

Gravel  distinguished  from  salts,  i.  1, 
3,  9. 

Gravitation,  iv.  2,  4. 

Green  sickness.  See  Chlorosis. 
Grief,  iii.  1,  2,  10. 

Gripes  of  children,  i.  1,  2,  5,  iv.  2, 1, 
3. 

Gustus  acrior,  i.  1,  5,  4. 

imminutus,  i.  2,  5,  8. 

Gum,  red,  i.  1,  2,  3,  ii.  1,  3, 12. 

Gutta  rosea,  ii.  1,  4,  6,  iv.  1,  2,  13, 
and  14. 

serena,  i.  2,  5,  5. 

H 

Hemorrhage,  arterial,  i.  1, 1,  3. 

of  the  lungs,  i.  1,  1,  4. 
of  the  nose,  i.  1,  1,  5. 
venous,  i.  2, 1,  5. 
of  the  rectum,  i.  2, 1, 6. 


Hemorrhage  of  the  kidnies,  i.  2, 1,  7. 

of  the  liver,  i.  2, 1,  8. 
Hemoptoe  arterial,  i.  1,  1,4. 

venous,  i.  2,  1,  9. 

Ilemorrhois  cruenta,  i.  2,  1,  6,  iv.  2, 
4,  8. 

alba,  i 1,  2,  12. 

Hair,  grey,  i.  2,  2,  11. 
new,  i.  1,  2, 15. 

white  by  uterine  pressure,  i. 

2.  2,  11 

Hallucination  of  sight,  ii.  1 7,  5. 

of  hearing,  ii.  1,  7,  6. 
maniacal,  iii  1,  2,  1. 
Hallucinatio  studiosa.  iii.  1,2,  2. 
Ilarrowgate  water,  factitious,  i.  1,  4, 
12 

Head-ach.  See  Hemicrania  and  Ce- 
phalaea. 

Hearing,  acuter,  i.  1,  5,  2. 

diminished,  i.  2,  5,  6. 
Heart-burn,  i.  2,  4.  5. 

Heart  stimulated,  Suppl.  i.  11,  7,  i. 
16,  9. 

Heat,  animal,  i.  1,  2, 1,  i.  1,  2,  3. 
sense  of  acuter,  i.  1,  5,  6. 
elemental,  iv.  2,  4. 
hectic  lessened  by  swinging, 
iv  2.,  1.  10 

not  perceived  by  the  lungs, 
iii.  1,  1,  10. 

not  estimated  by  thermome- 
ters, Suppl.  i.  7. 
of  the  breath,  Suppl.  i.  2,  2. 
Hemicrania  idiopathica,  i.  2,  4,  12. 

sympathetica,  iv.  2,  2,  8, 
iv.  2,  4,  3.  Suppl.  1, 
14,  3. 

relieved  by  mercury,  iv 

. 2,  2,  8. 

Hemiplegia,  iii.  2,  1,  10. 

Hepatis  tumour,  i.  2,  3,  9. 

Hepatitis,  ii.  1,  2,  12. 

chronica,  ii.  1,  4,  12. 
Herpes,  ii-  1,  5,  8. 

nephritica,  iv.  1,  2,  11. 
Hiccough,  ii.  1,  1,  6,  iv.  1,  1,  7. 
Hip-joint  injured,  i.  2,  2,  17. 
Hoarseness,  ii.  1,  3,  5,  iii.  2,  1,  4. 
Hordeolum,  ii.  1,  4,  4. 
Hooping-cough,  ii.  1,  3,  8. 

Horses,  broken  wind  of,  i.  2,  4,  9. 

catarrh  of,  ii.  1,  3,  6. 
Humectation  of  the  body,  iv.  ’ , 4,  7. 
Hunger,  i.  2,  4,  2. 

Hydatides,  in  calves,  i.  2,  5,  4. 
Hydrocele,  i.  2,  3, 11. 
Hydrocephalus  inter,  i.  2,  3, 12,  i.  2, 
5,  4,  iii.  2,  1,  10. 


518 


INDEX  TO  THE  CLASSES. — Part  ir. 


Hydrocephalus  from  inflammation, 

1.  2,  3, 12. 

Hydrogen  gas,  Suppl.  i.  9,  3,  i.  11,  4. 

in  fevers,  Suppl.  i. 
11,  6,  i.  16,  9. 

Hydrothorax,  i.  2,  3,  14,  case  of,  iv. 

2,  2, 13. 

Hydro-carbonate  gas,  Suppl.  i.  9,  1, 
Suppl.  i.  15,  3. 

Hydrops  ovarii,  i.  2,  3,  15. 
Hydrophobia,  i.  3,  1,  11,  iii.  1,  1,  15, 
iv.  1,2,7,  iv.  2,4,11. 
Hypochondriasis,  i.  2,  4,  10. 
Hysteralgia  frigida,  i.  2,  4,  17. 
Hysteria,  i.  3,  1,  10,  Suppl.  i.  8, 
11. 

from  fear,  iv.  3,  1,8. 
from  cold,  iv.  3,  3,  3. 
convulsions  in,  iii.  1,  1,  5. 
laughter  in,  iii.  1,  1,  5. 
Hysteritis,  ii.  1,  2,  16. 

I 

Jactitatio,  iii.  1,  1,  1. 

Jaundice,  i.  1,  3,  8,  i.  2,  4, 19. 

Icterus,  i.  1,  3,  8,  i.  2,  4,  19. 

Ileus,  i.  3,  1,  6,  ii.  1,  2,  11. 
Impotentia,  ii.  2,  2,  3. 

Indigestion,  i.  3,  1,  3. 

See  Anorexia  and  A- 
pepsia. 

from  cold  feet,  iv.  2,  1 , 
6,  Suppl.  i.  8,  5. 
Incubus,  iii.  2, 1,  13. 

Infants,  green  stools  of,  i 1,  2,  5. 

new  born,  ii.  1,  1, 13. 
Inflammation  of  the  eye,  ii.  1,  2,  2. 

superficial,  ii.  1,  4,  1. 
of  the  brain,  ii.  1,  2,  3. 
of  the  lungs,  ii.  1, 2,4. 

superfici- 
al, ii.  1,  3,  7. 
of  the  pleura,  ii.  1,  2, 
5. 

of  the  diaphragm,  ii. 
1,  2,  6. 

of  the  heart,  ii.  1,  2,  7. 
of  the  peritoneum,  ii. 
1,  2,  8. 

of  the  mesentery,  ii.  1, 
2,9. 

of  the  stomach,  ii.  I, 

2,  10. 

super- 
ficial, ii.  1,  3, 19. 
of  the  bowelsrii.  1,  2, 
11. 


Inflammation  of  the  bowels,  superfi- 
cial, ii.  1,  3,  20. 
of  the  liver,  ii.  1,  2, 12. 
chronica],  ii.  1,  4,  12. 
of  the  spleen,  ii.  1,  2, 

13.  Suppl.  i.  16,  6. 
of  the  kidnies,  ii.  1,  2, 

14. 

of  the  bladder,  ii.  1,  2, 

15. 

of  the  womb,  ii.  1,  2, 

16. 

of  the  tonsils,  ii.  1,  3, 

3. 

of  the  parotis,  ii.  1,  3, 

4. 

Inirritability  of  lacteals,  i.  2,  3,  26. 

of  lymphatics,  i.  2,  3, 
27. 

of  the  gall-bladder,  1, 
2,  4, 19. 

of  the  kidney,  i.  2,  4, 

20. 

of  the  spleen,  Suppl.  i. 
16,  6. 

vicissitudes  of,  i.  1, 1. 
Innutrition  of  bones,  i.  2,  2,  14. 
Inoculation,  ii.  1,  3,  9. 

Insanity,  quick  pulse  in,  iii.  1,1. 

from  parturition,  iii.  1,  2. 
from  paralysis,  iii.  1,  2. 
with  fever,  iii.  1,  2. 
cure  of,  iii.  1,  2. 
confinement  in,  iii.  1,  2. 
cures  other  diseases,  i.  2, 
3,  16. 

Insensibility,  ii.  2,  1,  1. 
Introsusception  of  the  intestine,  i 
3,  1,  6. 

Ira,  iii.  1,2,  17. 

Ischias,  ii.  1, 2,  18,  i.  2,  4,  15. 

Issues,  use  of,  i.  1,  2,  9,  iii.  1,  1,  ll 
Itch,  ii.  1,  5,  6. 

Itching,  i.  1,5,  9. 

of  the  nose,  iv.  2,  2,  6 

K 

Kanguroo,  i.  2,  2,  14. 

L 

Labour,  difficult,  i.  2,  2,  14. 
Lachrymarum,  fiuxus,  svm.  iv.  1,  2, 

1. 

Lameness  of  the  hip,  i.  2,  2,  17. 

Lassitude,  iii.  2,  1,  1 

Laughter,  iv.  2,  3,  3,  iii.  1,  1,  4,  iv. 

1,  3,3. 


INDEX  TO  THE  CLASSES  — Part  II. 


519 


Laughter.  See  Risus. 

Lead,  pernicious,  i.  2,  4,  8. 

Leg  one  shorter,  i.  2,  2,  17. 

Lepra,  ii.  1,  5,  3. 

Lethargus,  iii.  2,  1,  14. 

Lethi  timor,  iii.  1,  2,  14. 

Lice,  i,  1,  4, 15. 

Lientery,  i 2,  3,  6. 

Life  of  an  egg,  iv  1, 4.  1. 

of  winter-sleepers,  iv.  1,  4,  2. 
Light  debilitates  in  fevers,  i.  2,  5,  3. 
Lingua  arida,  i.  1, 3,  1,  iv.  2,  4,  11. 
Liver,  torpor  of,  i.  2,  2,  6. 
tumor  of,  i.  2,  3,  9. 
inflamed,  ii.  1,  2, 12. 

Lochia  nimia,  i.  2. 

Locked  jaw,  iii.  1,  1,  13. 

Love,  sentimental,  iii.  1,  2,  4. 

Lues  venerea,  ii.  1,  5,  8. 

imaginaria,  iii.  1,  2,  21. 
Lumbago,  ii.  1,  2,  17,  iii.  1,  1,  1. 

cold,  i.  2,  4,  16. 
Lumbricus,  i.  1,4,  10. 

Lunar  influence  on  the  solids,  i.  2,  1, 
11. 

Lungs,  adhesions  of,  ii.  1,  2,  5. 

not  sensible  to  heat,  iii.  1,  1, 

10. 

Lusus  digitorum  invitus,  iv.  1,  3,  4. 
M 

Macula  vultus,  i.  2,  1,  9. 

Madness,  mutable,  iii.  1,  2,  1. 
Magnetic  fluid,  iv.  1,  4,  5. 
Mammarum  tumor,  iv.  2,  1,  19. 
Mammularum,  tensio,  iv.  2,  1,  6,  i.  1, 
4,  7. 

Mania  mutabilis,  iii.  1,  2,  1. 

Matter,  variolous,  ii.  1,  3,  9. 

contagious,  ii.  1,  3,  ii.  1,  6, 

11. 

enclosed,  ii.  1,  6,  11. 
oxygenated,  ii.  1,  6,  6. 
sanious,  ii.  1,  6,  15. 

Measles,  ii.  1,  3, 10,  Suppl.  i.  16,  6. 
Membranes,  what,  iv.  1,  2. 
Menorrhagia,  i.  2,1,  11. 

Mercury,  crude,  as  a clyster,  i.  3,  1, 

6. 

in  colic  from  lead,  i.  2,  4, 

8. 

in  all  contagions,  Suppl.  i. 
16,  7. 

in  vertigo,  iv.  1,  2,  11. 
Miliaria,  ii.  1,  3,  12. 

Milk,  new,  for  children,  i.  1,  2,  5. 

old,  induces  costiveness,  ii.  2, 
2,  7. 


Milk-crust,  ii.  1,  5,  12. 

Miscarriage.  See  Abortion. 

Maeror,  iii  1,  2,  10. 

Mobility,  iv.  1,  2. 

of  the  skin,  Suppl.  1,  7. 
Mollities  ossium,  i.  2,  2,  14. 

Moon,  effect  of,  iv.  2,  4. 

Morbilli.  See  Rubeola- 
Mortification,  ii.  1,  6,  17,  iii.  2, 1, 10. 
Morpiones,  i.  1,4,  14. 

Mucus  diminished,  i.  2,  2,  4. 

of  the  throat  cold,  i.  2,  3,  1. 
of  the  bowels,  i.  2,  3,  6,  i.  1, 2, 
12. 

of  the  lungs,  i.  1,  3,  4. 
forms  stones,  i.  1,  3,  9. 
distinguished  from  pus,  ii.  1, 
6,  6. 

Mumps,  ii.  1,  3,  4. 

Murmur  aurium,  iv.  2,  1, 1.5. 

Muscat  volitantis,  i.  2,  5,  3. 

N 

Nails,  biting  of,  iv.  1, 3,  5. 

Nares  arida,  i.  1,  3,  3. 

Nausea,  dry,  i.  2,  4,  3. 

humid,  i.  3,  2,  3. 
ideal,  iv.  3,  2,  1. 
from  conception,  iv.  3,  2,  2. 
Navel-string  of  infants,  ii.  1,  1,  12. 

cut  too  soon,  ii.  1,  1, 12. 
Neck  thickens  at  puberty,  iv.  1,  2, 7. 
Neck-swing,  i.  2,  2,  16. 

Necrosis  ossium,  ii.  1,  4,  19. 
Nephritis,  ii.  1,  2,  14,  i.  1,  3,  9,  iii.  2, 
1,  14. 

Nerves  decussate,  iii.  2,  1,  10. 
Nictitation  irritative,  i.  1,  4,  1. 

sensitive,  ii.  1,  1,  9. 
involuntary,  iv.  1,  3,  2. 
Night-mare,  iii.  2,  1,  13. 

Nipples,  tension  of,  i.  1,  4,  7,  iv,  2, 

1,  6. 

want  of,  ii.  1, 1,  13. 
Nostalgia,  iii.  1,  2,  6. 

Nostrils,  dry,  i.  1,  3,  3. 

O 

Obesitas,  i.  2,  3,  17- 
Odontalgia,  i.  2,  4,  13. 

Odontitis,  ii.  1,  4,  7. 

(Esophagi  scirrhus,  i.  2,  3,  25. 
Oifactus  acrior,  i.  1,  5,  3. 

imminutus,  i-  2,  5,  7. 

Oil  destroys  insects,  i.  1,  4,  14. 
essential  of  animals,  i.  1,  2,  14. 


INDEX  TO  THE  CLASSES.— Paht  H. 


520 

Oil,  why  injurious  in  erysipelas,  ii. 

1,  3,  2. 

Opthalmy,  internal,  ii.  1,  2,  2. 

superficial,  ii.  1,  4,  1. 
Opium  in  catarrh,  i.  2,  3,  3. 

in  diaphragmitis,  ii.  1,  2,  6. 
Orci  timor,  iii.  1,  2,  15. 

Oscitatio,  ii.  1,  1,  10. 

Ossium  innutritio,  i.  2,  2, 14. 

Otalgia,  i.  2, 4,  13,  iv.  2,  2,  8. 

Otitis,  ii  1,4,  8. 

Otopuosis,  ii.  1,  4,  8. 

Ovary,  dropsy  of,  i.  2,  3, 15. 

exsection  of,  i.  2,  3,  15. 
Oxygen  gas,  Suppl.  i.  9,  3. 

in  fevers,  Suppl.  i.  11,  7,  i. 
16,  9. 

Oxygenation  of  blood,  iv.  1,  4,  6. 

P 

Pain  exhausts  sensorial  power,  iv. 

2,  2. 

greater  prevents  less,  iv.  2,  2, 

2. 

nervous,  i.  2,  4. 
of  the  little  finger,  symptom, 
iv.  2,  2,  12. 

of  arm  in  hydro  thorax,  iv.  2, 
2,  13. 

of  the  bile  duct,  iv.  2,  2,  4. 
of  the  shoulder,  iv.  2, 2,  9. 
of  the  pharynx,  iv.  2,  2,  5. 
of  the  testis,  iv.  2,  2, 11. 
smarting,  i.  1,  5,  10. 
of  the  side,  i.  2,  4,  14,  iv.  1,  2, 
16. 

of  menstruation,  i.  2,  1,  12. 
use  of,  iii.  1, 1, 11,  i.  1,  2,  9. 
of  the  uterus,  i.  2,  4,  17. 

Paint,  white,  dangerous,  ii.  1,4,  6. 
Palate,  defect  of,  i.  2,  2,  20. 

Paleness,  i.  2,  2,  2. 

from  fear,  iv.  3,  1,  5. 
from  sickness,  iv.  2, 1,  4. 
of  urine  after  dinner,  iv. 
2,  1,  2. 

from  cold  skin,  iv.  2,  1,  1. 
Palpitation  of  heart,  i.  3,  3,  2,  i.  2,  1, 

10. 

from  fear,  iv.  3, 1,  6. 
relieved  by  arsenic,  iv. 
2, 1,  18. 

Pancreas,  torpor  of,  i.  2,  2, 7. 
Pantiiculatio,  ii.  1, 1,  10. 

Panting,  ii.  1,  1,  4,  i.  3,  3,  3. 
Paracentesis  at  the  navel,  i.  2,  3, 13. 
Paralysis,  iii.  2, 1, 10. 

of  the  bladder,  iii.  2, 1,  6. 


Paralysis  of  the  rectum,  iii.  2,  1,  7- 
of  the  hands,  iii.  2, 1,  4. 
cure  of,  iii.  2.  1,  4. 
Paraplegia,  iii.  2,  1,  11. 

Paresis  inirritativa,  i.  2,  1,  2,  Suppl. 

i.  8, 10. 

sensitiva,  i.  2,  1,  3. 
voluntaria,  iii.  2,  1,  8. 
Paronychia,  internal,  ii.  1,  2,  19. 

superficial,  ii.  1,  4,  5. 
Parotitis,  ii.  1,  3,  4 
Parturition,  ii.  1,  1, 13,  ii.  1,2, 16. 

more  fatal  in  high  life, 

ii.  1,  1, 13. 

with  convulsion,  iii.  1, 1, 

iii.  1,  1,  7. 
difficult,  i.  2,  2,  14. 

Passions  depressing  and  exciting, 

iv.  3,  1,  5. 

Paupertatis  timor,  iii.  1,  2,  13. 
Pediculus,  i.  1,  4,  15. 

Pemphigus,  ii.  1,  3,  14. 

Penetration  of  animal  bodies,  iv.  1, 
4,7. 

Peripneumonv,  ii.  1,  2,  4. 

tracheal,  ii.  1,  2,  4. 
superficial,  ii.  1,  3,  7. 
inirritative,  ii.  1,  2, 
4. 

Peritonitis,  ii.  1,  2,  8. 

Perspiration  not  an  excrement,  i.  1, 
2,  14. 

greatest  in  the  hot  fit, 
i.  1,  2,  3. 
fetid,  i.  1,2,  14. 
Pertussis,  ii.  1,  3,  8. 

Pestis,  ii.  1,  3,  13. 

Petechia,  i.  2,  1,  17. 

cure  of,  Suppl.  i.  2,  7, 
Pharynx,  pain  of,  iv.  2,  2,  5. 
Phosphorus,  ii.  2,  2,  3. 

Phrenitis,  ii.  1,  2,  3. 

Phthisis,  pulmonary,  ii.  1,  6,  7- 
Piles,  bleeding,  i.  2, 1,  6. 

white,  i.  1,2,  12. 

Pimples  on  the  face,  ii.  1,  4,  6. 

Pins  swallowed,  ii.  1,  1,  7- 
Placenta,  ii.  1,  1, 12,  ii.  1,  2, 16. 
Plague,  ii.  1,  3, 13. 

Plasters,  why  moist,  i.  1,  3,  6. 
Pleurisy,  ii.  1,  2,  5. 

Pleurodyne  chronica,  i.  2,  4,  14. 

rheumatica,  iv.  1,  2,  16. 
Podagra,  iv.  1,  2,  15,  iv.  2,  4,  9. 
Polypus  of  the  lungs,  i.  1,  3,  4. 

of  the  nose  from  worms,  iv. 
1,  2,  9. 

Pregnancy,  ii.  1, 1,  12. 

Priapismus,  i.  1,  4,  6,  ii.  1,  7,  9. 


INDEX  TO  THE  CLASSES.— Pam  II. 


Proctalgia,  i.  2,  4,  18. 

Prolapsus  ani,  i.  1, 4,  9. 

Pruritus,  i.  1,  5,  9. 

narium  a vermibus,  iv.  2, 

2,  6. 

Psora,  ii.  1,  5,  6. 

imaginaria,  iii.  1,  2,  22. 
Pterigion,  ii.  1,  4,  2. 

Ptyalismus.  See  Salivatio. 

Pubis  and  throat  sympathize,  iv.  2, 

1,  7. 

Puerperal  fever,  i.  2,  4,  9,  ii.  1,  6, 
16 

insanity,  iii.  1,  2,  1. 
Pulchritudinis  desiderium,  iii.  1,  2, 
12. 

Pullulation  of  trees,  iv.  1,  4,  3. 

Pulse  full,  why,  i.  1, 1, 1. 

strong,  how  determined,  i.  1, 

1,  1,  Suppl.  i.  16,  10 
soft  in  vomiting,  iv.  2,  1,  17. 
intermittent,  iv.  2,  1,  18. 
quick  from  paucity  of  blood, 

Suppl.  ii.  11,  4. 
quick  sometimes  in  sleep,  iii. 

2,  1,  12. 

quick  in  weak  people,  iii.  1, 1, 
iii.  2,  1,  Suppl.  i.  11,  4. 
slower  by  swinging,  iv.  2,  1, 
10. 

quick  in  chlorosis,  i.  2,  3,  10. 
Punctee  mucosa;  vultus,  i.  2,  2,  9. 
Purging.  See  Diarrhoea. 

Pus  diminished,  i.  2,  2,  3. 

distinguished  from  mucus,  ii.  1, 

6,6. 

R 

Ratiocinatio  verbosa,  iii.  2,  2,  3. 
Rabies,  iii.  1,  2, 18. 

Rachitis,  i.  2,  2,  15. 

Raucedo,  catarrhal,  ii.  1,  3,  5. 

paralytic,  iii  2,  1,  5. 
Reasoning,  false,  iii.  2,  2,  3. 
Recollection,  loss  of,  iii.  2,  2,  1. 
Recti  paralysis,  iii.  2,  1,  7. 

scirrhus,  i.  2,  3,  23. 

Red-gum,  ii.  1,  3,  12,  i.  1,  2,  3. 
Redness  from  heat,  ii.  1,  7,  7. 
of  joy,  ii.  i,  7,  8. 
after  dinner,  iv.  1,  1,  1. 
of  anger,  iv.  2,  3,  5. 
of  guilt,  iv.  2,  3,  6. 
of  modesty,  2,  3,  6. 
Respiration,  ii.  1,  1,  2. 

quick  in  exercise,  ii.  1, 
1,  3. 


521 

Respiration  in  softness  of  bones,  i. 
2,  2,  14 

Restlessness,  iii  1,  1,  1. 

Retroversio  uteri,  i.  2,  1,  14. 
Reverie,  iii  1,  2,  2,  iv.  2,  4,  2. 
Rhaphania,  iii.  1,  1,  6. 

Rheumatism,  iv.  1,  2,  16. 

of  the  joints,  iv.  1,  2, 
16. 

of  the  bowels,  iv.  1,  2, 
16. 

of  the  pleura,  iv.  1,  2, 
16. 

suppurating,  iv.  1,  2, 
16. 

from  sympathy,  iv.  2, 
2,  13. 

chronical,  i.  1,  3,  12, 
iii.  1,  1,  6. 

venesection  in,  iv.  1, 
2,  16. 

Rickets,  i.  2,  2, 15. 

Ring-worm,  ii.  1,  5,  10. 

Risus,  iii.  1, 1,  4,  iv.  2,  3,  3. 
sardonicus,  iv.  1,  2,  4. 
invitus,  iv.  1,  3,  3. 

Rubeola,  ii.  1,  3,  10. 

Rubor  a calore,  ii.  1,  7,  7. 

jucunditatis,  ii.  1,  7,  8. 
pransorum,  iv.  1, 1,  1. 

Ructus,  i 3,  1,  2. 

Ruminatio,  i.  3,  1, 1,  iv.  3,  3, 1. 

S 

Sailing  in  phthisis,  ii.  1,  6, 7. 
Salivation  warm,  i 1,  2,  6. 

lymphatic,  i.  3,  2,  2. 
sympathetic,  iv.  1,  2,  5. 
in  low  fevers,  i.  1,  2,  6. 
Salt  of  urine,  i.  1,  2,  4,  i.  1,  3,  9- 
Satyriasis,  iii.  1,  2, 16. 

Scabies.  See  Psora. 

Scald-head,  ii.  1,  5,  11. 

Scarlatina,  ii.  1,  3,  11. 

Sciatica  frigida,  i.  2,  4, 15. 

Scirrhus,  i.  2,  3,  22. 

suppurans,  ii.  1,  4,  14. 
of  the  rectum,  i.  2,  3,  23. 
of  the  urethra,  i.  2,  3,  24. 
of  the  oesophagus,  i.  2,  3, 
25. 

Scorbutus,  i.  2,  1.  15. 

suppurans,  ii.  1,  4,  14. 
Scrofula,  i.  2,  3,  21. 

suppurating,  ii.  1,  4,  13. 
produces  insanity,  iii.  1,  2. 
Scurf  of  the  head,  i.  1,  3, 6. 

3 X 


VOL.  II. 


522 


INDEX  TO  THE  CLASSES.— Paht  II. 


Scurf  of  the  tongue,  i.  1,  3,  1. 

Scurvy,  i.  2,  1, 15. 

suppurating,  ii.  1,  4,  14. 

Sea-air  in  phthisis,  ii.  1,  6,  7. 

Sea-sickness,  iv.  2,  1,  10.  Suppl.  i. 
8,  3. 

Seat,  descent  of,  i.  1,  4,  9. 

Seed,  ejection  of,  ii.  1,  1,  11. 

See-saw  of  old  people,  iii.  2,  1,  2. 

Sensation  inert,  Suppl.  i.  6,  4. 

Sensitive  association,  law  of,  iv.  2, 

2,2.  __ 

Setons,  ii.  1,  6. 

Shingles,  ii.  1,  5,  9. 

Shoulder,  pain  of,  iv.  2,  2,  9. 

Shrieking,  iii.  1,  1,  3. 

Sickness,  i-  2,  4,  4,  i.  3,  2,  3. 

cured  by  a blister,  iv.  1, 
1,3. 

by  warm  skin,  iv.  1,  2,  2, 
Suppl-  i.  11,  4. 
by  whirling,  i.  1,  1,  4. 
by  swinging,  Suppl. i.  15,3. 
by  hydrocarbonate  gas, 
Suppl.  >•  15,  3. 

See  Nausea. 

Sight  acuter,  i.  1,  5,  1- 
impaired,  i.  2,  5,  2. 

Side,  chronical  pain  of,  i.  2,  4, 14. 

Sighing  and  sobbing,  iii.  1,  2,  10. 

Sitis,  calida,  i.  2,  4,  1. 
frigida,  i.  2,  4,  1. 
defectus,  ii.  2,  2,  2. 

Skin  pale  in  old  age,  i-  2*2,  2. 
from  cold,  i.  2,  2,  2. 
dry,  i.  1,  3,  6. 
yellowish,  i.  2,  2,  2. 
bluish  and  shrunk,  i.  2,  1,  1. 
reddish,  ii.  1,  3,  1. 
cold  after  meals,  iv.  2, 1,  1. 

Sleep,  iii.  2, 1,  12. 

interrupted,  i.  2, 1,  3. 
periods  in,  iv.  2,  4,  1. 
with  quick  pulse,  iii.  2,  1,  12. 
disturbed  by  digestion,  iii.  2, 
1, 12.  ... 

Sleep-walkers,  iii.  1,  1,  9. 

Small-pox,  ii-  1,  3,  9. 

why  distinct  and  conflu- 
ent, Suppl.  i.  15,  2,  i. 
16,  8. 

secondary  fever  of,  ii.  1, 

6, 12. 

eruption  of,  iv.  1,  2, 12. 

Smarting,  i.  1,  5,  10. 

Smell,  acuter,  i.  1,  5,  3. 

impaired,  i.  2,  5,  7- 

Sneezing,  ii.  1,  1,  3,  iv.  1,  2,  2. 

Snow  in  scrofula,  i.  2,  3,  21. 


Snow  in  paralysis,  iii.  2,  1,  4. 

Snuff  in  hydrocephalus,  i.  2,  3,  12. 
Softness  of  bones,  i.  2,  2,  14. 
Somnambulism,  iii.  1,  1,  9. 

Somnium,  ii.  1,  7,  4. 

Somnus,  iii.  2,  i.  12,  iv.  2,  4,  1. 

interruptus,  i.  2,  1, 3. 
Spasm  of  diaphragm,  iii.  1,  1,  11. 

of  the  heart,  iii.  1,  1,  11. 
Spine  distorted,  i.  2,  2,  16. 
protuberant,  i.  2,  2,  18. 
bifid,  i.  2,  2,  19. 

Spitting  blood,  i.  1,  1,  4,  i.  2,  1,  9. 
Spleen  swelled,  i.  2,  3,  18.  Suppl.  i. 
16,  6. 

Splenitis,  ii.  2,  2,  13. 

Spots  on  tile  face,  i.  2,  2,  9. 

seen  on  bed  clothes,  i.  2,  5,  3. 
Squinting,  i.  2,  5,  4. 

in  hydrocephalus,  i.  2, 
5,4. 

Stammering,  iv.  2,  3,  1. 

Stays,  tight,  injurious,  ii.  1,  1,  12. 
Sterility,  ii.  2,  2,  4. 

Sternutatio,  ii.  1,  1,  3,iv.  1,  2,  2. 

a lumine,  iv.  2,  1,2. 
Stimulants,  their  twofold  effect,  ii. 
1,  2,  6. 

injure  weak  people,  i. 
1,  2,  3. 

except  the  sor- 
bentia,  i.  1,  2, 
3. 

Stocks  for  children  dangerous,  ii.  2, 
2,  17. 

Stomach,  torpor  of,  i.  2, 1,  2,  Suppl. 
i.  12,  i.  8,  10,  i.  16,6. 
inflammation  of,  ii.  1,  2, 
10,  ii.  1,  3, 19. 
its  association,  iv.  1,  1. 
cause  of  fever,  Suppl.  i.  8, 
8. 

Stones  in  the  bladder.  See  Calculi. 

in  horses,  i.  1,  3,  5,  i.  1,  3, 10. 
Strabismus,  i.  2,  5,  4. 

Strangury,  ii.  1,  1, 12,  iv.  2,  2,  2. 

convulsive,  iv.  2,  2,  3. 
Strength  and  debility  metaphors,  i. 
2,  1. 

Stridor  dentium,  iii.  1,  1,  12. 

Studium  inane,  iii.  1,  2,  2,  iv.  2,  4,  2. 
Stultitia  inirritabilis,  i.  2,  5,  1. 

insensibilis,  ii.  2,  1,  1. 
voluntaria,  iii.  2,  2,  2. 

Stupor,  i.  2,  5,  10.  Suppl.  i.  15. 

Stye,  ii-  1,  4,  4. 

Subsultus  tendinum,  iii.  1, 1,  5. 

Sudor.  See  Sweats. 

Suggestion,  slow,  iv.  2,  3,  8. 


ENDEX  TO  THE  CLASSES  — Paht  II. 


523 


Superannuation,  iv.  2,  3,  8. 

Surprise,  i.  1,  5,  12. 

Sweats,  warm,  i.  1,  2,  3. 
cold,  i.  2,  3,  2. 
lymphatic,  i.  3,  2,  7. 
asthmatic,  i.  3,  2,  8,  iv.  3,  1, 
2. 

covered  in  bed,  iv.  1,  1,  2. 

Suppl.  i.  11,  6. 
of  the  brows,  i.  1,  2,  3. 
in  fevers  fits,  why,  i.  1,  2,  5. 
from  exercise,  i.  1,  2,  3. 
from  heat,  i.  1,  2,  3. 
from  medicines,  i.  1,  2,  3. 
Sweaty  hands  cured,  i.  3,  2,  7. 
Swinging,  ii  1,  6,  7. 

makes  the  pulse  slower, 
iv.  2,  1,  10. 

Swing,  centrifugal,  Suppl.  i.  15,  and 
3. 

Symbols  of  ideas,  iv.  2,  3,  8. 
Sympathy,  direct  and  reverse,  iv.  1, 

I,  F. 

with  others,  iii.  1,  2,  24. 
of  various  parts,  Suppl. 

1.  11,5. 

reverse  of  lacteals  and 
lymphatics,  Suppl.  i. 

II,  5. 

of  capillaries,  Suppl.  i. 
11,  5. 

direct  of  stomach  and 
heart,  Suppl.  i.  11,  5. 
how  to  destroy,  iv.  2,  2, 
8. 

of  throat  and  pubis,  iv. 

2,  1,  7. 

Syncope,  i.  2,  1,  4. 

epileptic,  iii.  2,  1,  15. 
Syngultus,  ii.  1,  1,  6. 

nephriticus,  iv.  1,  1,  7. 
Syphilis,  ii.  1,  5,  2. 

imaginaria,  iii.  1,  2,  21. 
Syphon  capillary  of  cloth,  ii.  1,  8,  1. 

T 

Tactus  acrior,  i.  5,  5. 

imminutus,  i.  2,  5,  6. 
Taedium  vitx,  ii.  2,  1,  2,  iii.  1,  2,  11, 
iii.  2,  1,  8. 

Taenia,  i.  1,  4,  11. 

Tape-worm,  i.  4,  1, 1. 

Tapping  at  the  navel,  i.  2,  3,  13. 
Tarditas  senilis,  iv.  2,  3,  8. 

paralytica,  iv.  2,  3,  7. 
Tarsitis,  ii.  1,4,  3. 

Taste.  See  Gustus. 


Taste,  bitter,  not  from  bile,  i.  1,  3, 1. 
Tears,  sympathetic,  iv.  1,  2,  1,  iii.  1, 
1,  10. 

Teeth,  to  preserve,  i.  1,  4,  5. 

fall  out  whole,  ii.  1,  4,  7- 
Tenesmus,  ii.  1,  1,  11. 

calculosus,  iv.  1,  2,  8. 
Testium  dolor  nephriticus,  iv.  2,  2, 
11. 

tumor  in  gonorrhoea,  iv.  1, 
2,  18. 

tumor  in  parotide,  iv.  1,  2, 
19. 

Tetanus  trismus,  iii.  1,  1,  13. 

dolorificus,  iii  1,  1,  14. 
Thirst.  See  Sitis  and  Adipsia. 
Thread-worm,  i.  1,  4, 12. 

Throat  swelled,  i.  2,  3,  20. 

thickens  at  puberty,  iv.  2,  1, 
7. 

grown  up,  i.  2,  3,  25. 

Thrush,  ii.  1,  3,  17. 

Tic  doloureux,  i.  2,  4,  12. 

Tickling,  i.  1,  5,  8. 

Timor  orci,  iii.  1,  2,  15. 
lethi,  iii.  1,  2,  14. 
paupertatis,  iii.  1,  2,  13. 
Tinea,  ii.  1,  5,  11. 

Tinnitus  aurium,  iv.  1,  1,  15. 
Titillatio,  i.  1,  5,  8. 

Titubatio,  linguae,  iv.  2,  3,  1. 
Tobacco,  smoke  of,  in  piles,  i.  2,  1, 
6. 

Tongue,  dry,  i.  1,  3,  1.  Suppl.  1,  2. 

coloured  mucus,  i.  1,  3,  1. 
Tonsillitis,  ii.  1,  3,  3. 

Tonsils  swelled  from  bad  teeth,  i.  2, 
3,  21,  ii.  1,  3.  3. 

Tooth-ach,  i.  2,  4,  12,  ii-  1,  4,  7. 
Tooth-edge,  iv.  1,  2,  3. 

Toothing,  i.  1,  4,  5. 

Tooth-powder,  i.  1,  4,  5. 

Torpor  of  the  liver,  i.  1,  2,  6. 

of  the  pancreas,  i.  2,  2,  7. 
of  the  lungs,  Suppl.  1,  9. 
of  the  stomach,  Suppl.  i.  10. 
of  the  heart,  Suppl.  i.  10. 
Touch.  See  Tactus. 

deceived  three  ways,  i.  2, 
5,  9,  iv.  2,  1,  10. 

Transfusion  of  blood,  i.  2,  3,  25, 
Suppl.  i.  14,  4. 

Translation  of  matter,  i.  3,  2,  9. 

of  milk,  i.  3,  2,  10. 
of  urine,  i-  3,  2,  11. 
Transparency  of  cornea,  i.  1,  4,  1. 

of  crystalline,  i.  2,  2, 
13. 


524 


INDEX  TO  THE  CLASSES. — Part  II. 


Transparency  of  air  before  rain,  i. 

1.  4,  1. 

Tremor  of  old  age,  iii.  2,  1,  3. 
of  fever,  iii.  1,  1,  2. 
of  anger,  iv.  3,  1,  4. 
of  fear,  iv.  1,  2,  5. 

Tricks  of  the  face,  iii.  1,  1,  5,  iv.  1, 
3,  2. 

Trismus,  iii.  1, 1,  13. 

dolorificus,  i.  2,  4,  12. 
Twitchings  of  the  face,  iv.  I,  3,  2. 
Tussis  ebriorum,  ii.  1,  1,  5. 
convulsiva,  iii.  1,  3,  8. 
hepatica,  iv.  2,  1,2. 
arthritica,  iv  2,  1,  9. 
periodica,  iv.  3,  4,  2. 
a pedibus  frigidis,  iv.  2,  1,  7. 
Tympany,  i 2,  4,  9. 

Typhus,  i.  2,  1,  1,  ii.  1,  3,  1. 

U 

Ulcers,  healing  of,  i.  1,  3,  13. 

of  the  cornea,  i 1,  3,  14. 
from  burns,  i.  1,  3,  13. 
scrofulous,  ii.  1,  4,  13. 
of  the  throat,  ii.  1,  3,  3,  ii.  1, 
3,  11. 

of  the  legs,  ii.  1,  4,  14. 
Unguium  morsiuncula,  iv.  1,  3,  5. 
Urethra,  scirrhus  of,  i.  2,  >,  24. 

fistula  of,  ii  1,  4,  11. 

Urine,  copious,  coloured,  i 1,  2,  4. 
copious,  pale,  i.  2,  3,  5. 
diminished,  coloured,  i.  1,3, 
7. 

diminished,  pale,  i.  2,  2,  5. 
its  mucus,  salts,  Prussian 
blue,  i 1,  2,  4. 

why  less  and  coloured  in 
dropsies,  i.  1,  3,  7. 
translation  of,  i.  3,  2,  11. 
difficulty  of,  iii  2,  1,  6. 
not  secreted,  i 2,  2,  8. 
pale  after  meals,  iv.  2,  1,  2- 
pale  from  cold  skin,  iv.  2, 1, 3. 
sediment  in  fevers,  Suppl.  i. 
2,3. 

pale  in  fevers,  Suppl.  i.  2,  3, 
and  5. 

Urticaria,  ii.  1,  3,  16. 

Uteri  descensus,  i 1,  4,  8. 
retroversio,  i.  2,  1,  14. 

V 

Varix,  i.  2,  1,  19. 

Vacillatio  senilis,  iii.  2,  1,  2 
Varicella,  ii.l,  3,  15. 


Variola,  ii.  1,  3,  9. 

eruption  of,  iv.  2, 1,  12. 
Vasorum  capil.  retrogressio,  i.  3,  3, 

1 

Venereal  orgasm,  iv.  1,  4,  4. 
disease,  ii.  1,  5,  2. 
imaginary,  iii.  1,  2,  21. 
Ventriculi  sgritudo,  i.  2,  4,  4. 

vesicatorio  sa- 
nata,  iv.  1, 1, 
3. 

Vermes,  i.  1,  4,  10. 

Vertigo  rotatory,  iv.  2, 1,  10. 
of  sight,  iv.  2, 1,  11. 
inebriate,  iv.  2,  1,  12. 
of  fever,  iv.  2,  1,  13. 
from  the  brain,  iv.  2,  1,  14. 
of  the  ears,  iv.  2,  1,  15. 
of  the  touch,  taste,  and 
smell,  iv.  2,  1,  16. 
with  vomiting,  iv.  2,  3,  2. 
produces  slow  pulse,  iv.  2, 
1,  10. 

of  blind  men,  iv.  2,  1,  10. 
use  of  mercurials  in  it,  iv. 
. 2,  1,  11. 

Vibices,  i.  2,  1,  16,  Suppl.  i.  2,  7. 
Vigilia,  iii.  1,  2,  3,  iv.  1,  3,  6. 
Vinegar,  in  petechia:,  i.  2,  1,  17. 

in  scarlet  fever,  i.  1,  3,  11. 
Vision  acuter,  i.  1,  5,  1. 

diminished,  i.  2,  5,  2. 
expends  much  sensorial  pow- 
er, i.  2,  5,  3. 

Vita  ovi,  iv.  1,  4,  1. 

hiemi-dormientium,  iv.  1,  4,  2. 
Vitus’s  dance,  iv.  2,  3,  2. 

Volition,  three  degrees  of,  iii.  2,  1, 
12 

lessens  fever,  iii  2,  1,  12, 
Suppl.  i 11,  6. 
produces  fever,  iii.  2, 1, 12. 
without  deliberation,  iii.  1. 
1,  iv.  1,  3,  2. 

Vomica,  ii.  1,  6,  3. 

Vomitus,  i.  3,  1,  4. 

Vomendi  conamen  inane,  i.  3,  1,  8. 
Vomiting  stopped,  iv.  1,  1,  3,  iv.  1. 

in- 
voluntary, iv.  3,  3,  2. 
how  acquired,  iv.  1,  1,  2. 
F. 

vertiginous,  iv.  3,  2,  3. 
from  stone  in  ureter,  iv. 
3,2,4. 

from  paralytic  stroke,  iv. 
3,  2,  5. 

from  tickling  the  throat, 
iv.  3,  2,  6. 


INDEX  TO  THE  CLASSES.— Pabt  II. 


Vomiting  sympathizes  with  the  skin, 
iv.  3,  2,  7. 

in  hsmaptoe,  i.  1,  I,  4. 
from  defect  of  association, 
iv  2,  1,  10. 

Vulnerum  cicatrix,  i.  1,  3,  13. 

W 

Watchfulness,  iii  1,  2,  3,  iv.  3,  2,  5. 
Water-qualm,  i.  3,  1,  3. 

Weakness,  three  kinds  of,  i.  2, 1. 
Whirling-chair,  Suppl.i.  15,  3. 
Whirling-bed,  Suppl.  i.  15,  7,  i.  2, 
5,  5. 

White-swelling,  of  the  knee,  i.  2, 
3,  19. 

Whitlow,  superficial,  ii.  1,  4,  5. 

interna],  ii.  1,  2,  19 
Wine  in  fevers,  ii.  1,3,  l,iv.  2, 1, 12. 


525 

Winking,  ii.  1,  1,  8,  i.  1,  4,  1,  iv.  3, 

2,  2. 

Winter-sleeping  animals,  iv.  1,  4,  2. 
Womb,  descent  of,  i.  1,  4,  8 

retroversion  of,  i.  2,  1,  14. 
inflammation  of,  ii.  1,  8,  16. 
Worms,  i.  1,  4,  10. 

mucus  counterfeits,  i.  1,  3, 
4. 

in  sheep,  i.  1,  4,  10. 
Wounds,  healing  of,  i.  1,3,  13. 

Y 

Yawning,  ii.  1,  1,  9. 

Yaws,  ii.  1,  5,  5. 

Z 

Zona  ignea,  ii.  1,  5,  9,  iv.  1,  2, 11,  ii. 
1,  2,  14, 


1 


